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Health Expect. 2018 Apr;21(2):528-538. doi: 10.1111/hex.12647. Epub 2017 Nov 28.

A three-goal model for patients with multimorbidity: A qualitative approach.

Author information

1
Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
2
The Dutch Council for Health and Society (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, The Netherlands.
3
The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
4
Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
5
Family Medicine Department, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
6
Dutch College of General Practitioners, Utrecht, The Netherlands.
7
Radboud University Medical Center/Radboudumc Alzheimer Center, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

To meet the challenge of multimorbidity in decision making, a switch from a disease-oriented to a goal-oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed.

OBJECTIVE:

This study aimed to develop conceptual descriptions of goal-oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity.

METHOD:

Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis.

RESULTS:

Clinicians distinguished disease- or symptom-specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. "Fundamental goals" are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations.

CONCLUSION:

Based on the perspectives of clinicians, we expanded the concept of goal-oriented care by identifying a three-level goal hierarchy. This model could facilitate collaborative goal-setting for patients with multiple long-term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice.

KEYWORDS:

collaborative goal-setting; decision making; elderly; fundamental goals; goal-oriented care; multimorbidity

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