Collaborative Goal Setting Research Articles

Clinical communication preferences in cystic fibrosis and strategies to optimize care.

The importance of optimizing communication between clinicians and individuals and families living with cystic fibrosis (CF) about daily care, adherence, and related psychosocial concerns is well documented. The purpose of this study was to gain an understanding of interpersonal communication experiences and preferences among individuals and families living with CF as they engage with the clinical team. The study also aimed to reveal opportunities for enhancing future interpersonal communication practices. Five U.S. CF care centers participated in the following activities: (a) On-site observation of clinic interactions during outpatient visits; (b) On-site 1:1 interviews with individuals living with CF, their family members, and CF clinicians; (d) Focus groups conducted in person with CF care team members; (d) Focus groups conducted virtually with adults and family members with CF. Content analysis of transcripts and constant comparative methods were used to identify emergent themes. Four themes related to participants' needs and preferences for clinic interactions emerged during analysis: (a) eliciting psychosocial concerns, (b) addressing childhood development and transitions, (c) negotiating agendas and sharing decisions, and (d) educating to enhance CF conversations. CF clinicians and individuals and families living with CF expressed the need for resources and training to engage in better conversations with each other. Participants identified areas of high priority, including working together around social, psychological, and economic challenges, preparation for transition to adulthood, and sustaining daily care. Findings point to the value of developing advanced communication skills that foster trust-building, negotiating agendas, active listening, and collaborative goal-setting.

Educational Impact on Therapists’ Knowledge, Beliefs, and Actions: A Pilot Study

Purpose: Collaborative goal setting has been shown to be an effective way to promote client engagement leading to improved outcomes; however, healthcare professionals face challenges when implementing collaborative goal setting into their clinical practice. The purpose of this study was to evaluate the effectiveness of educational workshops to 1) increase a therapist’s knowledge of motivational interviewing and action planning, 2) promote collaboration between therapists and their patients/clients, 3) promote collaboration between therapists and their interdisciplinary team and 4) increase the ease of implementation of motivational interviewing and action planning skills into a therapist’s clinical practice. Method: A mixed-methods design was utilized. Occupational therapists and physical therapists were recruited via email to participate. Data were collected via online surveys at three different times (before the first educational workshop, after the second workshop, and three months after the second workshop) consisting of quantitative related survey questions assessing the participants’ knowledge, beliefs, actions, and perceived self-efficacy related to motivational interviewing and action planning and qualitative questions focused on typical goal development processes, level of collaboration and challenges associated with developing goals with clients and interdisciplinary team members and anticipated/resultant impact and meaning of participation in the educational workshops. Results: The sample included 19 participants. Quantitative data demonstrated a statistically significant increase in self-scoring related to knowledge, beliefs, and actions when comparing all the pre-education to the post-education scores, except for one (collaboration with interdisciplinary team members). A follow-up analysis on this criterion demonstrated no statistically significant changes over the three-month period, potentially indicative of retention of the material covered. The qualitative data provided further insight into the challenges faced by participants and the perceived benefits of participating in the educational workshops. Conclusion: The educational workshops appeared to be effective in addressing some of the barriers to collaborative goal setting (e.g. lack of time, knowledge/skills, appropriate patients, concern for duplication of services) found in the literature, most notably providing the participants with the knowledge and skills needed, which is the first step when implementing collaborative goal setting into clinical practice. Further research in this area is recommended.

Conceptualizing the key components of rehabilitation following major musculoskeletal trauma: A mixed methods service evaluation.

The reorganization of acute major trauma pathways in England has increased survival following traumatic injury, resulting in an increased patient population with diverse and complex needs requiring specialist rehabilitation. However, national audit data indicate that only 5% of patients with traumatic injuries have access to specialist rehabilitation, and there are limited guidelines or standards to inform the delivery of rehabilitation interventions for individuals following major trauma. This group concept mapping project aimed to identify the clinical service needs of individuals accessing our major trauma rehabilitation service, prioritize these needs, determine whether each of these needs is currently being met, and plan targeted service enhancements. Participants contributed towards a statement generation exercise to identify the key components of rehabilitation following major trauma, and individually sorted these statements into themes. Each statement was rated based on importance and current success. Multi-dimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for targeted service enhancement. Fifty-eight patients and health care professionals participated in the ideas generation activity, 34 in the sorting, and 49 in the rating activity. A 7-item cluster map was agreed upon, containing the following named clusters: Communication and Coordination; Emotional and psychological wellbeing; Rehabilitation environment; Early rehabilitation; Structured therapy input; Planning for home; and Long-term support. Areas for targeted service enhancement included access to timely and adequate information provision, collaborative goal setting, and specialist pain management across the rehabilitation pathway. The conceptual framework presented in this article illustrates the importance of a continuum of rehabilitation provision across the injury trajectory, and provides a platform to track future service changes and facilitate the codesign of new rehabilitation interventions for individuals following major trauma.

Newly registered nurses' experiences of delivering patient education in an acute care setting: an exploratory study.

Nurses' education of patients is important for building the knowledge and skills necessary for self-management. Little is known of newly registered nurses' preparedness to deliver patient education, or of their experiences in clinical contexts where they may encounter barriers. The aim of this study was to explore newly registered nurses' patient education role in an acute hospital setting. A purposive sample of seven newly registered nurses from an NHS teaching hospital in England were interviewed to explore their understanding and experiences of educating patients. An interpretive phenomenological approach was used to analyse responses. Three superordinate themes were identified: the professional self; the ward environment; and the nurse-patient relationship. Tensions existed between the ideals newly registered nurses brought to registered practice and the practice-based realities of patient education, which was often delivered informally with limited patient involvement in collaborative goal setting. Few newly registered nurses recalled more than superficial preparation in university for the role and some were encouraged by senior colleagues to downplay the importance of patient education. The patient-education aspirations of newly registered nurses need to be nurtured. Educational institutions have an important role to play as do experienced nurses, making explicit the education they routinely deliver and supporting newly registered nurses to build their own pedagogic expertise.

Interprofessional simulation in a student community clinic: insights from an educational framework and contact theory

IntroductionSimulation in community care is a relatively understudied area. In this paper, we report a qualitative evaluation of the Simulated Client Interprofessional Education (SCIPE) program in a community clinic for undergraduate health and social care students in a rural setting. We sought to explore the stakeholders’ perceptions and experiences of training for, and conduct of, a simulated client-based activity to support the development of collaborative practice of students. We used an educational framework (presage, process, product–3P) and contact theory to analyse the evaluation data and suggest improvement strategies.MethodsData on professional characteristics was collected from facilitators, simulated client and students. Facilitators and simulated clients received training. Written evaluations were collected after training and after the simulated clinics. Purposively sampled facilitators, students and community partner agencies participated in individual semi-structured interviews to gain deeper insights into experiences.ResultsFourteen clinics involved 5 facilitators, 12 simulated clients and 40 students. Fifteen interviews were conducted. The SCIPE program led to perceived improvements in students’ communication and awareness of interprofessional collaboration. Participation in the program enabled students to experience a holistic approach to client interviewing and development of competency in collaborative goal setting. Further attention to presage and ability of facilitators to build positive contact conditions was identified. Coordination from a central site facilitated exchange and quality assurance for all elements of the program. Scoping of conditions of positive contact enabled a greater understanding of students’ and facilitators’ evaluation of the experience and constraints which would be modifiable for future improvement and sustainability.DiscussionAlthough the SCIPE program benefited students, the need for more explicit organisational engagement and support was revealed in interviews. The use of 3P and contact theory was helpful in identifying elements of the program for maintenance and development. Future research could follow students into practice to see if the behaviours are sustained and translated. Strengths included broad stakeholder involvement and immediate feedback. The key limitation was that the activity lacked explicit institutional support, facilitators required further training in briefing and the outcomes largely refer to participants’ perceptions and may not translate to practice.

Feasibility, user experiences, and preliminary effect of Conversation Cards for Adolescents\xa9 on collaborative goal-setting and behavior change: protocol for a pilot randomized controlled trial

BackgroundAdolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents© (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i) assess the feasibility of CCAs in a real-world, practice setting to inform full-scale trial procedures, (ii) assess user experiences of CCAs, and (iii) determine the preliminary effect of CCAs on changing behavioral and affective-cognitive outcomes among adolescents.MethodsStarting in early 2019, this prospective study is a nested mixed-methods, theory-driven, and pragmatic pilot randomized controlled trial with a goal to enroll 50 adolescents (13–17 years old) and 9 physicians practicing at the Northeast Community Health Centre in Edmonton, Alberta, Canada. Adolescents will collaboratively set one S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goal with their physician to implement over a 3-week period; however, only those randomized to the experimental group will use CCAs to inform their goal. Outcome assessments at baseline and follow-up (3 weeks post-baseline) will include behavioral, affective-cognitive, and process-related outcomes.DiscussionIn examining the feasibility, user experiences, and preliminary effect of CCAs, our study will add contributions to the obesity literature on lifestyle modifications among adolescents in a real-world, practice setting as well as inform the scalability of our approach for a full-scale effectiveness randomized controlled trial on behavior change.Trial registrationClinicalTrials.gov Identifier: NCT03821896.

ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists

ABSTRACT Background: Collaborative goal-setting is a fundamental component of developmental physical and occupational therapy practice. Evidence suggests, however, that therapists struggle to elicit patient and family goals, and they often establish goals that are not reflective of patient and caregiver functional preferences. Training and efficiency also act as barriers to collaborative goal-setting. A number of solutions have been proposed to enhance the goal-setting process, but none specifically address relevant areas of functioning within the International Classification of Functioning, Disability and Health (ICF), a robust, multidimensional tool that emphasizes the importance of function. To support pediatric therapists in the collaborative establishment of functionally relevant goals, an ICF-inspired goal-setting tool was developed through the assimilation of a large body of existing scientific evidence, ICF Core Sets, and expert consensus. Objective: The aims of this paper are to: 1) describe an ICF-inspired framework for collaborative goal-setting in developmental rehabilitation that seeks to reduce the methodological challenges frequently associated with goal-setting; and 2) discuss the conditions for the use of the framework in daily therapeutic practice. Conclusions: The goal-setting framework presented in this paper may help pediatric therapists to create meaningful goals in collaboration with patients and families. Importantly, the goal-setting framework described promotes the use of the ICF in therapeutic practice.

Setting up for Success: Implementing a Learning outcomes-based Pre-class Communication Process

Librarians in a teaching and learning department at a large research institution linked their pre-class communications process to learning outcomes for foundational information literacy. Doing so enabled clearer messaging, collaborative goal setting, and more focused information literacy classes.

DIVERSITY IN HOSPICE AND END-OF-LIFE EXPERIENCES: THE INFLUENCE OF CHRONIC DISEASE AND SOCIOCULTURAL FACTORS

Hospice provides supportive and palliative services to persons nearing the end-of-life. Use of the Medicare hospice benefit has grown to cover nearly half of all Medicare decedents. Even more notably, hospice agencies now serve patients with a diverse range of terminal conditions, including those not traditionally served by hospices, such as dementia and heart failure. In addition to expanded use of hospice care by patients with multiple types of chronic disease, demographic transitions in the United States over the last several decades have also led to increased use of hospice services among patients with diverse socio-cultural and linguistic backgrounds. Limited research has identified the unique experiences of patients enrolled in hospice who have diagnoses of dementia and heart failure, or explored how socio-cultural factors act to influence the course and outcomes of hospice care. This symposium features interdisciplinary collaborations between academic researchers and clinical practitioners at a large non-profit hospice agency in a multicultural urban environment. These collaborations, which draw on multiple theoretical perspectives and research methodologies, shed new light on patient experiences in hospice and identify opportunities for improving care and comfort at end-of-life. Presentations will include an exploration of the unique symptoms and experiences of hospice patients with heart failure, an evaluation of a clinical program for heart failure hospice patients, an exploration of collaborative goal setting between patients-providers, and an examination of cultural health capital as it relates to race/ethnic and socioeconomic disparities in hospitalization among hospice patients, and factors for disenrollment among hospice patients with dementia.

Rehabilitation professionals’ views on social media use in traumatic brain injury rehabilitation: gatekeepers to participation

Purpose Rehabilitation professionals support people with traumatic brain injury (TBI) to return to meaningful participation in life and society – which now includes the use of social media. However, the role of health professionals in supporting the use of social media by adults with TBI is not yet known. This study aimed to investigate the experiences and views of rehabilitation professionals on the use of social media by people with TBI during rehabilitation. Method Two focus groups were conducted and analysed qualitatively for content themes. Results Eleven rehabilitation professionals, including allied health, recreational therapy, and service management, took part in this study. Participants identified potential benefits to people with TBI using social media, including reduced social isolation. However, they expressed concerns about social media risks relating to the vulnerability, exploitation, and reputation management for people with TBI. Rehabilitation professionals viewed their role as being to protect people from these risks of harm, either through imposing restrictions on social media use or responding to problems after these occurred. Conclusion A knowledge translation approach might help guide and support rehabilitation professionals in enabling adults with TBI to safely access and experience the benefits of meaningful engagement in social media during rehabilitation. Implications for rehabilitation Rehabilitation professionals can start addressing social media use during collaborative goal setting, in order to support people with traumatic brain injury to use social media successfully during rehabilitation and beyond. To do this, professionals can inquire as to the person’s previous social media use and identify priority areas for the person for short- and long-term goals. Rehabilitation targeting social media use should include instruction for participation in social media platforms, providing education and feedback that is positive and constructive, as well as risk management education. Policy and guidance is needed for rehabilitation professionals to more actively support people with traumatic brain injury to access social media for improved participation and inclusion in online communities. Addressing social media goals in rehabilitation should be informed by existing successful traumatic brain injury rehabilitation approaches (e.g., functional rehabilitation) and adopting strategies used in rehabilitation supporting other higher risk goals (e.g., return to driving).

\u201cWhat would you like to achieve?\u201d Goal-Setting in Patients with Dementia in Geriatric Rehabilitation

BackgroundSetting meaningful, individualized rehabilitation goals is an essential part of the rehabilitation process. Even though patients with dementia are a drastically increasing patient group in geriatric rehabilitation, empirical data about meaningful rehabilitation goals and collaborative goal-setting in this target group is missing. Cognitive impairment and lack of insight in current deficits have been discussed as barriers for participation in goal-setting, but require empirical examination.This study investigated the feasibility of a semi-structured versus a structured goal-setting approach and the types of goals, rehabilitation patients with mild to moderate dementia perceive as personally relevant. Insights in acute functional and motor deficits, differentiated by cognitive status were explored.MethodsCohort study in a geriatric rehabilitation center. Semi-structured and ICF-based, structured interviews were applied to explore patients` rehabilitation goals. Patients` insight in deficits was operationalized as the relationship of self-ratings and objective measures of linked clinical assessments for the same functional construct.ResultsPatients (n = 101, MMSE 22 ± 2.6, age 83.9 ± 5.9 years) stated the improvement of mobility-related functions and self-care activities (> 70%) but also psychological well-being such as handling stress or mood (> 38%) as most important rehabilitation goals. The structured interview facilitated goal-setting and provided a broader view of rehabilitation needs. Correlations between self-ratings and clinical assessments were medium to high (rho = 0.29 to 0.83) with highest associations for key motor features. Trend tests identified a significant trend between values of the clinical assessment and categories of self-ratings (p ≤ 0.01) with lower cognitive status derogating this relationship.ConclusionsCollaborative goal-setting was feasible, especially when supported by a structured approach and yielded a large spectrum of functional but also psychological rehabilitation needs from the patients` perspective. Patients showed sustained insight in their actual functional impairments, limited in a subgroup of patients with more advanced cognitive impairment.

Clinical Nurse Specialist Preceptor Protocol.

Develop an evidence-based clinical nurse specialist (CNS) preceptor protocol to enhance preceptor's skills and effectiveness and strengthen the preceptor-preceptee relationship and outcomes. An effective CNS preceptor is a key variable to quality, timely, and fiscally responsible CNS transition and retention. Most preceptors receive no formal education or skill development. Literature searched from the previous 10 years explored CNS preceptor, preceptee, and preceptorship process. Protocol key components are development of the mutual collaborative relationship, shared meaning, understanding, goal setting, timelines, and evaluations. The planning phase of the protocol includes face-to-face meeting to identify overarching goals and establish a trusting collaborative relationship. The mutual iterative learning and growing phase includes identification of learning needs, goals, and strategies such as debriefing, reflective journaling, and mutual ongoing evaluation. The concluding phase includes formal evaluation. The outcome phase includes safe autonomous CNS practice, along with mutual growth and satisfaction. The literature informed the CNS preceptor protocol development. The protocol may be evaluated within a preceptor-preceptee relationship across multiple settings. Higher levels of CNS research are vital to identify evidence-based CNS preceptorship strategies. As CNSs are integrated into advanced practice roles, a structured preceptor protocol and education program is critical to provide quality outcomes.

Effect of Telephone-Delivered Collaborative Goal Setting and Behavioral Activation vs Enhanced Usual Care for Depression Among Adults With Uncontrolled Diabetes

Depression symptoms are present in one-third of patients with diabetes, contributing to significant adverse consequences. Population screening of high-risk patients coupled with telephone delivery of evidence-based therapies for comorbid diabetes may address barriers to care. To evaluate the effectiveness of proactive population screening plus telephone delivery of a collaborative goal-setting intervention among high-risk patients with uncontrolled diabetes and depression. In this randomized clinical trial, 225 participants (intervention [n = 136] and control [n = 89]) were enrolled from a regional Veterans Healthcare System serving Southeast Texas from November 1, 2012, through June 24, 2016. Data were gathered at baseline and 6 and 12 months after intervention. Patients selected had uncontrolled diabetes (hemoglobin A1c [HbA1c] >7.5%]) and clinically significant depression (Patient Health Questionnaire-9 scores [PHQ-9] ≥10) and were living more than 20 miles from the Veterans Affairs medical center. Data collection was completed on December 6, 2016, and final analyses were completed by January 25, 2018. All analyses were intent to treat. Healthy Outcomes Through Patient Empowerment (HOPE) included 9 telephone sessions with 24 trained health care professionals using collaborative goal-setting and behavioral activation methods. The control group received enhanced usual care (EUC) and notification of high-risk status. Change in depression symptoms using PHQ-9 and glycemic control using HbA1c from baseline to 6 months and to 12 months. Secondary analyses evaluated clinically significant responses for these measures. Among 225 participants, 202 (89.8%) were men, the mean (SD) age was 61.9 (8.3) years, 145 (64.4%) were married, and 156 (69.3%) had some education beyond high school. For the overall study, 38 participants (16.9%) were lost to follow-up or withdrew at 6 months and another 21 (9.3%) were lost to follow-up or withdrew at 12 months. Repeated-measures analysis with multiple imputation for missing data assessing the interaction of treatment group (HOPE vs EUC) and time (baseline, 6 months, and 12 months) found no significant improvement in PHQ-9 (β, 1.56; 95% CI, -0.68 to 3.81; P = .17) or HbA1c (β, -0.005; 95% CI, -0.73 to 0.72; P = .82). Analyses using t test for change from baseline to 12 months showed a HOPE vs EUC between-group mean difference for PHQ-9 of 2.14 (95% CI, 0.18 to 4.10; P = .03) and for HbA1c of -0.06% (95% CI, -0.61% to 0.50%; P = .83). A secondary analysis of patients experiencing a clinical response found that 52.1% of HOPE participants had clinically significant responses in PHQ-9 at 12 months vs 32.9% in EUC (difference, 0.19; 95% CI, 0.04-0.33; P = .01). Telephone-delivered, collaborative goal setting produced clinically significant reductions in depression symptoms but not glycemic control among patients who remained engaged at 12 months compared with EUC among a population screened sample of high-risk patients with diabetes and depression. Although the intervention created some lasting effect for depression, additional strategies are needed to maintain engagement of this high-risk population within an interprofessional team approach to primary care. ClinicalTrials.gov identifier: NCT01572389.

Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study.

Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help-seeking behaviours, treatment decision-making and long-term care of those diagnosed with mental illness. This study was planned to explore the diversity of explanatory models among family caregivers at a centre for recovery-oriented rehabilitation services in South India. The sample for this study included 60 family caregivers of patients referred to Psychiatric Rehabilitation Services within a tertiary-care hospital for mental health and neurosciences. Bart's Explanatory Model Inventory, including a semi-structured interview and a checklist, assessed the family caregivers' explanatory model of distress on five domains: identity, cause, timeline, consequences and control/cure/treatment. The results indicated the coexistence of multiple causal explanatory models including psychosocial, supernatural, situational and behavioural contributors. While 36.7% of the caregivers displayed two explanatory models, 33.3% of the caregivers held three explanatory models and 16.6% of the caregivers endorsed four explanatory models. Caregivers shared their concerns about varied consequences of mental illness but less than half of them were aware of the name of the psychiatric disorder. While they accessed various forms of treatments and adjunctive supports such as prayer, medication was the most frequently used treatment method. The findings have implications for collaborative goal setting in recovery-oriented services for persons with mental illness and their families.

Caregiver creation of participation-focused care plans using Participation and Environment Measure Plus (PEM+), an electronic health tool for family-centred care.

Family-centred care (FCC) is a model for rehabilitation practice that focuses on collaborative partnerships between providers and clients (i.e., children and their caregivers). FCC is a best-practice standard and is expected to yield better outcomes for children and greater caregiver satisfaction with rehabilitation services. A commonly cited barrier to implementing FCC is perceptions about caregiver capability to contribute to designing an initial plan of care, due to lack of skill and/or interest. The aim of this study is to address FCC barriers through three objectives: (a) report the proportion of caregivers that created multiple care plans using PEM+, an electronic health tool, (b) assess the proportion of caregivers that created complete and participation-focused care plan(s) and that exceeded criteria of a complete plan, and (c) describe characteristics of caregivers that did not create a complete care plan. Study objectives were addressed via secondary analyses of a subset of data from the PEM + pilot trial. Participants were caregivers (N = 18) of children with developmental disabilities (aged 0-5 years) receiving rehabilitation services in an early childhood programme. A deductive analytic approach was used to code care plan content to criteria and to determine proportion of caregivers with a complete and participation-focused care plan and those that exceeded the criteria. Multiple care plans were created by 72% of the caregivers, 83% caregivers created at least one care plan that was complete and participation-focused per criteria, and 83% exceeded the criteria. The high occurrence of caregivers who developed multiple care plans and who developed high-quality care plans, in their completeness and participation-focused features, suggests that caregivers are interested and capable of participating in a collaborative goal setting process when using PEM+. This indicates that FCC is feasible to implement in clinical workflow with the use of an electronic health tool, which may better facilitate such care. PEM+ warrants further efficacy testing prior to implementation.

Development of a Tablet Application for Collaborative Goal-setting in School-based Occupational Therapy: The Aid for Decision-Making in Occupation Choice for Schools (ADOC-S)

ABSTRACTIntroduction: This study aimed to develop a new tablet application named the Aid for Decision-making in Occupation Choice for School (ADOC-S). It aims to assist with conducting collaborative occupation-based goal-setting by sharing decision-making with a team member (child, parent, teacher, and occupational therapist) using a consultation model of school-based occupational therapy (SBOT). Method: This developmental study involved two phases: (1) using a focus group technique to develop the concept and prototype of the ADOC-S, and (2) using a Delphi-style method to reach a consensus among eight experienced occupational therapists regarding the ADOC-S items, text, and images. Then, we reported its use in SBOT practice with a single case example of a school-aged child in Japan. Results: First, the concept and the prototype application of ADOC-S was created. Then, after two Delphi rounds, the eight occupational therapists reached a consensus that 68 items in four categories were included in the ADOC-S: Self-care (17 items); Communication (9 items); School life (22 items); and Play (20 items). The case study illustrated how to use the ADOC-S and its efficacy for collaborative goal-setting in SBOT. Conclusion: The ADOC-S appears to promote collaborative goal-setting in SBOT. This application now needs to be clinically tested.

Patient-Centered Goal Setting in Developmental Therapy: Discordance between Documented Goals and Caregiver-Perceived Goals.

Productive interactions between engaged patients and clinical teams are key to effective clinical practice. Accordingly, the identification of needs and priorities through the process of collaborative goal setting is fundamental to patient-centered care. Executing a goal-setting process that is truly collaborative is challenging; many caregivers do not feel that they are adequately involved in the goal-setting process. This study presents the results of an initiative intended to understand goal concordance between therapists and caregivers. We conducted an observational, cross-sectional design study. Twenty-nine pediatric physical and occupational therapists developed and documented collaborative goals for their patients. Over 6 months, 120 randomly selected caregivers from a weekly list of patients scheduled for a follow-up physical or occupational therapy visit participated. Caregivers completed structured interviews related to their children's therapy goals. We calculated agreement coefficients between caregiver-perceived goals and therapist-documented goals. Overall strength of agreement was poor (M = -0.03, SD = 0.71). There were no significant differences within variables of a goal setter, goal importance, or goal utility. Median agreement coefficients were greatest for goals perceived to be identified solely by the caregiver, perceived as important, and perceived as functionally useful. The results of this study underscore the state of discordance in the collaborative goal-setting process in pediatric physical and occupational therapy. Healthcare encounters continue to be framed by provider perspectives and priorities. Developing therapy goals that enhance family involvement, relate to function, and are important to the healthcare consumer may improve the agreement.

Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis

BackgroundMultimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity.MethodsSemi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component.ResultsSixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes.ConclusionsOur study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients.

Involving community-dwelling older adults in activities related to meals as part of a rehabilitation program: a single-blinded cluster-controlled study

Objective: To understand if older adults have improvement in health-related quality of life, muscle strength, and nutritional status when involved in own meals as part of a rehabilitation program. Design: The study was single-blinded cluster-controlled consisting of two groups: intervention and control. Subjects: Intervention consisted of 62 participants and control of 61 recruited from, respectively, three and two aged care areas. Age was, respectively, 82.9 (±7.5) vs. 83.5 (±7.7) years. The proportion of female participants was, respectively, 42 (68 %) vs. 41 (67 %). Interventions: The healthcare staff had education related to food, meals, and nutrition, and older adults participated in an eight weeks rehabilitation program. Focus was on shopping, cooking, social context, and ability to eat and included collaborative goal setting with a case manager. Controls received usual community aged care. Main measures: The main outcomes were health-related quality of life measured by EuroQol-5D-3L (EQ-5D-3L), muscle strength (30 seconds chair-stand), and body weight. Data were analyzed with non-parametric and parametric statistics as appropriate. Results: There was a significant (P = 0.01) improvement of health-related quality of life (converted EQ-5D-3L score) in intervention (0.570 vs. 0.668) compared to the control (0.666 vs. 0.580) from baseline to follow-up. There was no difference in muscle strength between intervention and control: 15 (31 %) vs. 16 (32 %) improved 30 seconds chair-stand. There was no difference in weight change between the groups (−1 vs. −2.4 kg) (P = 0.261). Conclusions: Improvement in health-related quality of life was seen when older adults were involved in activities related to meals.

Relationship Consensus and Caregiver Burden in Adults with Cognitive Impairments 6 Months Following Stroke.

Caregiver burden is commonly experienced in caregivers of adults with cognitive impairment after stroke. This burden can be associated with caregiver-centered factors, including caregiver-perceived relationship quality. To examine the role of caregiver-perceived relationship quality on caregiver burden at 6 months following stroke. Prospective observational study. Community settings. Adults enrolled in two randomized controlled trials after stroke (n = 60) and their caregivers (n = 60). Three constructs of relationship quality (relationship consensus, cohesion, and satisfaction) were examined as predictors of caregiver burden (the Abbreviated Dyadic Adjustment Scale). A hierarchical logistic regression and a Poisson regression with robust standard errors were used to examine the effect of relationship quality on caregiver burden while controlling for characteristics of stroke survivors and caregivers. Caregiver burden was measured with the abridged version of the Zarit Burden Interview. Poor relationship consensus (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.06-2.07; P = .02) increased the odds of high caregiver burden after controlling for characteristics of stroke survivors (age, comorbidity, cognitive fluency) and caregivers (gender, self-reported health). Relationship cohesion (OR = 1.03; 95% CI = .84-1.25; P = .81) and relationship satisfaction (OR = 1.53; 95% CI = .75-3.10; P = .24) did not predict caregiver burden. Meaningful and agreeable goals and expectations between dyads are essential to reduce caregiver burden after stroke. Collaborative goal-setting between stroke survivors and their caregivers may be a promising intervention strategy to increase relationship consensus and reduce caregiver burden. III.