The ambiguity of goal-setting: a study of patients’ perspectives on goal-setting in outpatient multidisciplinary rehabilitation of patients with spinal cord injury

Abstract

Purpose Spinal cord injury (SCI) is a complex health condition requiring long-term rehabilitation. Person-centred goal-setting is a central component of rehabilitation. However, knowledge of patients’ perspectives on the goal-setting in SCI rehabilitation is scarce. The purpose was therefore to explore patients’ perspectives on goal-setting in multidisciplinary SCI rehabilitation. Materials and methods An anthropological study combining participant-observation and individual interviews. Data were analysed using reflexive thematic analysis. The COREQ checklist was used to report study quality. Results Patients with SCI perceived goal-setting as ambiguous. On the one hand, they considered it insignificant, because it was complicated to transform complex needs of everyday life to recommended criteria of goals being measurable, specific, and realistic. On the other hand, they considered it a potentially useful guiding tool. Patients were uncertain of impact of goals and perceived goal-setting as vague during rehabilitation. Patient involvement was challenged by insufficient integration of patients’ experience-based knowledge of everyday life and clinicians’ profession-based knowledge. Conclusions Goal-setting in rehabilitation is not the patients’ need but they accept it as the clinicians’ framework for rehabilitation. For goal-setting to become meaningful to patients with SCI, patient involvement should be strengthened by equally integrating the patients’ perspectives in the goal-setting process. Implications for rehabilitation Health-care professionals have to strengthen patient involvement in SCI rehabilitation by to a greater extent integrating the patients’ knowledge of their everyday life and preferences rather than primarily focusing on profession-based knowledge. Health-care professionals must support patients in setting goals which are practically meaningful and relevant to the patients’ everyday life and achievably and if needed go beyond the structured measurement of SMART goals. In an acknowledgement of the dynamic nature of goal-setting, clinicians should emphasise formulating goals in a flexible and non-directive manner, thereby providing room for patients’ changing needs and challenges over time. Goals in SCI rehabilitation cover a wide range from broad, value-based goals to more specific goals, and the health-care professionals must ensure inclusion of such a wide range of goals.