Keywords: goal-oriented care, goal-setting, patient-centeredness, chronic conditions, multimorbidity, concept analysis
The healthcare system is faced by an ageing population, increase in chronic conditions and multimorbidity. Multimorbid patients are faced with multiple parallel care processes leading to a risk for fragmented care. These problems relate to the disease-oriented paradigm. In this paradigm the treatment goals can be in contrast with what patients value.
The concept of goal-oriented care is proposed as an alternative way of providing care. There is a need to translate this concept into tangible knowledge so providers can better understand and use the concept in clinical practice. The aim of this study is to address this need by means of a concept analysis.
How can goal-oriented care be understood for people with chronic conditions in primary care?
This concept analysis using the method of Walker and Avant is based on a literature search in PubMed, Embase, Cochrane Library, PsychInfo, CINAHL, OTSeeker, and Web of Science. The method provides eight iterative steps: select a concept, determine purpose, determine defining attributes, identify model case, identify additional case, identify antecedents and consequences, and define empirical referents.
The analysis of 37 articles revealed that goal-oriented care is a dynamic and iterative process of three stages: goal-elicitation, goal-setting and goal-evaluation. The process is underpinned by the patient’s context and values. Provider and patient preparedness are required to provide goal-oriented care. Goal-oriented care has the potential to improve patients’ experiences and providers’ well-being, to reduce costs, and improve the overall population health. The challenge is to identify empirical referents to evaluate the process of goal-oriented care.
A common understanding of goal-oriented care is presented. Further research should focus on how and what goals are set by the patient, how this knowledge could be translated into a tangible workflow, and should support the development of a strategy to evaluate the goal-oriented process of care.
Points for discussion:
The balance between providing care based on clinical guidelines and providing care according to the patients' needs and preferences.
What is needed to convince professionals of apply goal-oriented care in their clinical practice?
'What matters to the patient?': what goals do patients set?