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


METHODS
Semi-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.


RESULTS
Sixteen 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.


CONCLUSIONS
Our 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.
['Vermunt|Neeltje|N|0000-0001-9607-8416', 'Elwyn|Glyn|G|', 'Westert|Gert|G|', 'Harmsen|Mirjam|M|', 'Olde Rikkert|Marcel|M|', 'Meinders|Marjan|M|']
D000328:Adult D001291:Attitude of Health Personnel D000080536:Decision Making, Shared D005260:Female D058005:General Practitioners D000072219:Geriatricians D006801:Humans D008297:Male D008875:Middle Aged D000076322:Multimorbidity D010347:Patient Care Planning D036301:Qualitative Research
Goal setting Goals Shared decision-making Older patients Multimorbidity Clinical geriatricians General clinicians