Goal-Setting in clinical practice: a study of health-care professionals’ perspectives in outpatient multidisciplinary rehabilitation of patients with spinal cord injury

Abstract

Purpose Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals’ perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury. Materials and methods An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality. Results Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach. Conclusions We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients’ perspectives in the practice is needed. Implications for rehabilitation To strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting. Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI. SMART goals are not always the right way to formulate rehabilitation goals. A flexible and pragmatic approach is needed to reach a balance between the patients’ complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.