Abstract
Background: Healthcare systems globally are shifting towards person-centred integrated care (PC-IC) to better support individuals with complex, long-term needs. Goal-oriented care (GOC), which aligns care with patients' personal goals and preferences, is one approach to care delivery which can support person-centred integrated care. However, applying GOC in practice requires interprofessional primary care teams to adopt new routines and skills. There is limited understanding of the specific skills and behaviours needed for integrating GOC into daily practice. Therefore, this study aims to explore how primary care providers (PCPs) apply GOC in their everyday work with patients.
Approach: An ethnography was conducted with PCPs who had completed a GOC pilot training between March 2022 and January 2023. Data were collected one year post-training through non-participatory observations combined with interviews that focused on PCP behaviours during patient interactions. Thematic analysis was conducted to show how GOC was delivered in primary care settings. Through member checks, participants contributed to the final description of the GOC behaviours.
Results: Sixteen PCPs were observed for 166 hours over 34 days (February-May 2024), involving 156 patient interactions and 29 interviews with providers. Participants included physical therapists, social workers, nurses, dietitian, general practitioner, speech therapist, and mental health professionals. Core behaviours that emerged as central to GOC included asking about expectations and goals, defining and recalibrating goals, and evaluating care actions. Additional actions supported the demonstration of this behaviour, such as PCPs engaging in discussions about emotions and the person’s context, which guided care decisions and empowered patients in care planning. PCPs promoted autonomy of the patient by sharing clinical information in an accessible way, enabling informed decision-making. Beyond directly observable actions, interviews revealed behaviours that PCPs viewed as essential to GOC but invisible to the observer. PCPs described being mindful of how they positioned themselves to encourage patient engagement. They also used their knowledge of patients’ lives to avoid burdening them with irrelevant details. Participants highlighted actions before or after patient interactions, such as discussing goals with colleagues, as impactful behaviours that support GOC in patient-provider contact.
Implications: This study shows that GOC involves both visible ("frontstage") and invisible ("backstage") behaviours. While the focus was on observable behaviours, interviews revealed that “backstage” processes also shape GOC delivery. Understanding these “backstage” elements can further add to the development of a skillset needed for applying GOC in practice. Future research should focus on the connection between patient and provider perspectives to refine GOC training for professionals. Identifying barriers and facilitators will also help policymakers and educators support GOC implementation in primary care.