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Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

BACKGROUND: Establishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and pa...

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Autores principales: Salter, Charlotte, Shiner, Alice, Lenaghan, Elizabeth, Murdoch, Jamie, Ford, John A, Winterburn, Sandra, Steel, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592350/
https://www.ncbi.nlm.nih.gov/pubmed/31160370
http://dx.doi.org/10.3399/bjgp19X704129
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author Salter, Charlotte
Shiner, Alice
Lenaghan, Elizabeth
Murdoch, Jamie
Ford, John A
Winterburn, Sandra
Steel, Nick
author_facet Salter, Charlotte
Shiner, Alice
Lenaghan, Elizabeth
Murdoch, Jamie
Ford, John A
Winterburn, Sandra
Steel, Nick
author_sort Salter, Charlotte
collection PubMed
description BACKGROUND: Establishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together. AIM: To determine the key components of the goal-setting process in general practice. DESIGN AND SETTING: In-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018. METHOD: Activity analysis was applied to 10 hours of video-recorded doctor–patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis. RESULTS: A total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient. CONCLUSION: Goal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals. Goal setting worked best when both GP and patient were prepared in advance.
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spelling pubmed-65923502019-07-11 Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations Salter, Charlotte Shiner, Alice Lenaghan, Elizabeth Murdoch, Jamie Ford, John A Winterburn, Sandra Steel, Nick Br J Gen Pract Research BACKGROUND: Establishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together. AIM: To determine the key components of the goal-setting process in general practice. DESIGN AND SETTING: In-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018. METHOD: Activity analysis was applied to 10 hours of video-recorded doctor–patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis. RESULTS: A total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient. CONCLUSION: Goal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals. Goal setting worked best when both GP and patient were prepared in advance. Royal College of General Practitioners 2019-07 2019-06-04 /pmc/articles/PMC6592350/ /pubmed/31160370 http://dx.doi.org/10.3399/bjgp19X704129 Text en © British Journal of General Practice 2019 This article is Open Access: CC BY 4.0 licence (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Research
Salter, Charlotte
Shiner, Alice
Lenaghan, Elizabeth
Murdoch, Jamie
Ford, John A
Winterburn, Sandra
Steel, Nick
Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title_full Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title_fullStr Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title_full_unstemmed Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title_short Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
title_sort setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592350/
https://www.ncbi.nlm.nih.gov/pubmed/31160370
http://dx.doi.org/10.3399/bjgp19X704129
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