A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation.
OBJECTIVE
To explore the ways clinicians engage rehabilitation patients in patient-centered goal setting and identify factors influencing the goal-setting process.


DESIGN
Ethnographic study utilizing observed practice-thematic analysis.


SETTING
Four rehabilitation wards of a large metropolitan hospital in Melbourne, Australia.


SUBJECTS
Participants included 17 rehabilitation patients, 18 allied health clinicians and one family member. Disciplines represented were speech pathology, occupational therapy, social work and physiotherapy.


METHOD
Multiple qualitative methods were used. A total of 18 routine goal-setting interviews between clinicians and patients were audio recorded and transcribed. Together with associated entries in the patient medical record, transcripts were coded and developed into themes using thematic analysis. Finally, focus groups with clinicians were conducted to validate themes identified.


RESULTS
Three themes were identified describing factors which influence patient centeredness: "a goal-setting collaboration"-the interpersonal exchange between client and clinician; "the environment"-physical, temporal and structural; and "clinician self-awareness"-clinicians' insight into the ways they influence goal setting. The practice of patient-centered goal setting varied considerably between clinicians. Goals developed were strongly influenced by the clinician's views, although strategies of respect for the patient and reflective listening skills increased patient participation and the patient centeredness of goals developed.


CONCLUSION
Goals developed with rehabilitation patients are more likely to be patient-centered when the interaction encourages the patient to express their needs and preferences, and these are heard by the clinician. For this to influence treatment, it must occur in an environment structured to support and value patient-centered goals.
['Cameron|Lisa J|LJ|https://orcid.org/0000-0001-7029-8437', 'Somerville|Lisa M|LM|https://orcid.org/0000-0001-7400-7342', 'Naismith|Catherine E|CE|', 'Watterson|Dina|D|', 'Maric|Valentina|V|', 'Lannin|Natasha A|NA|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000488:Allied Health Personnel D001315:Australia D005260:Female D006040:Goals D006801:Humans D008297:Male D008875:Middle Aged D010347:Patient Care Planning D010358:Patient Participation D018802:Patient-Centered Care D012046:Rehabilitation D055815:Young Adult
Allied health rehabilitation patient care planning patient-centered care qualitative study