Abstract
Introduction: The healthcare system deals with an ageing population and a rise in chronic conditions and multimorbidity. Patients with a combination of diseases are faced with multiple parallel care processes often leading to fragmentation of care. These problems relate to the disease-oriented paradigm wherein treatment goals can be in contrast with what patients value. A strategy to integrate the different processes might be to explicitly focus on the patients’ goals which is suggested in the concept of goal-oriented care (GOC). However, little is known about GOC; especially on how patients with chronic conditions or multimorbidity experience GOC during healthcare encounters.
Aims, objectives, theory or methods: This study aims to elicit the patients’ experiences on GOC and learn on how they currently see their personal goals being addressed in encounters with their primary healthcare professionals. A purposive sampling method was used to recruit patients with chronic conditions or multimorbidity who regularly consult one or more primary healthcare professional(s). A semi-structured interview guide was used to conduct in-depth interviews. All interviews were audio-taped, transcribed verbatim, and analyzed following a thematic approach.
Highlights or results or key findings: In total, 90 patients with chronic conditions or multimorbidity were interviewed. The patients reported that their goals were commonly addressed during encounters, either by professionals who explicitly asked them or by the patients themselves who intrinsically shared their goals. In some examples, patients mentioned that the professionals tended to focus more on health-related goals instead of their personal goals (e.g., adapting the medication scheme to control the blood pressure). In other examples, patients reported that they gave direction to their healthcare professionals by expressing what they value (e.g., learn to cycle again with a paralyzed leg). Patients reported that - to be able to share their goals - a trustful and open relationship with their professionals is important. Besides that, professionals need to be able to integrate the patients’ personal goals into the care plan. At the latest, primary healthcare professionals need more time to fully commit during encounters.
Conclusions: This study elicited the patients’ experiences regarding GOC and revealed that the patients’ goals were mostly addressed during healthcare encounters. A trustful relationship between the patients and the professionals and sufficient amount of time seemed to be important preconditions to elicit the patients’ personal goals.
Implications for applicability/ transferability, sustainability, and limitations: This study gave insight in whether and how patients see their goals being reflected in primary care encounters. In the future, professionals need to raise more awareness about the shift from health-related goals to the patients’ personal goals. Therefore, more guidance on how to provide GOC could be helpful.