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Olaleye OA, Agoro ZB. 'We don't have to do it together': a qualitative study of physiotherapists' and patients' perceptions about collaborative goal setting in Nigeria. Physiother Theory Pract 2024; 40:817-827. [PMID: 36447440 DOI: 10.1080/09593985.2022.2152645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The adoption of Collaborative Goal Setting (CGS) is limited in most rehabilitation settings in Nigeria despite its recommendations in clinical practice guidelines. OBJECTIVE To explore the perceptions of physiotherapists and patients about CGS at a tertiary healthcare facility in Ibadan, Nigeria. METHODS We conducted focus group discussions among purposively selected physiotherapists (n = 8) and patients (4 stroke survivors, 3 patients with brain injury) to qualitatively explore their perceptions. Audio-taped discussions were transcribed verbatim and thematically analyzed. RESULTS We identified four themes around CGS which were: 1) paternalistic view of goal setting; 2) physiotherapists as goal setters; 3) perceived benefits of collaborative goal setting; and 4) barriers and facilitators to CGS. The physiotherapists articulated goals as expected outcomes from treatment and believed they were better poised and experienced to determine what patients could achieve during each phase of treatment. Patients' view of goal setting agreed with the physio-therapists', as they also opined that goal setting is the responsibility of physiotherapists. Time constraint, inadequate knowledge and the inability of patients to appropriately articulate their goals and expectations from treatment were barriers to CGS. Concerns about who to collaborate with when dealing with patients with impaired cognition and/or disorders of consciousness were raised by the physiotherapists. Participants in both groups indicated that education on how to set patient-oriented goals could facilitate CGS. CONCLUSIONS Though rarely practiced, participants agreed that collaborative goal setting could be beneficial. Both the physiotherapists and patients require education on how to appropriately collaborate in setting goals of rehabilitation.
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Affiliation(s)
- Olubukola A Olaleye
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Zainab B Agoro
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Kamp A, Dybbroe B. Training the ageing bodies: New knowledge paradigms and professional practices in elderly care. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1730-1746. [PMID: 37291653 DOI: 10.1111/1467-9566.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Abstract
In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3-year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal-oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide.
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Affiliation(s)
- Annette Kamp
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Betina Dybbroe
- Department of People and Technology, Roskilde University, Roskilde, Denmark
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Paulus TM, Grubbs H, Rice-Moran R, Lester JN. How student healthcare providers in a communication skills course respond to standardized patient resistance. Soc Sci Med 2023; 337:116309. [PMID: 37879265 DOI: 10.1016/j.socscimed.2023.116309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes.
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Affiliation(s)
- Trena M Paulus
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Heather Grubbs
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Renee Rice-Moran
- Department of Curriculum and Instruction, Clemmer College, East Tennessee State University, 402 Warf-Pickel Hall, Johnson City, TN, 37614, USA.
| | - Jessica N Lester
- Department of Counseling and Educational Psychology, School of Education, 201 North Rose Avenue, Indiana University, Bloomington, IN, 47405-1006, USA.
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2023; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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Boeykens D, Decoster L, Lenoir D, De Sutter A, Haverals R, Lahousse L, Pype P, Van de Velde D, Boeckxstaens P, De Vriendt P. Building an understanding of goal-oriented care through the experiences of people living with chronic conditions. PATIENT EDUCATION AND COUNSELING 2023; 107:107567. [PMID: 36379862 DOI: 10.1016/j.pec.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To understand the concept of goal-oriented care (GOC) through the experiences of people with chronic conditions. METHOD Interviews with people living with chronic conditions (n = 50) were analyzed in two ways. A deductive approach based on GOC attributes generated in a concept analysis on GOC: goal-elicitation, goal-setting, goal-evaluation, patients' context, and patients' needs and preferences. An inductive approach based on a thematic analysis using descriptive phenomenology. RESULTS The phase of goal-elicitation was recognized by the participants, whereas goal-setting and goal-evaluation were experienced to a lesser extent. Regarding the underpinning attributes, mixed feelings were reported concerning the integration of the patient's context and the presence of their needs and preferences throughout the care process. The inductive analysis revealed specific attention to informing patients about their condition and treatment options and discussing goals in interprofessional collaboration. CONCLUSION Goal-elicitation was already present and seems to be a good foundation for GOC. More attention should be given to goal-setting and goal-evaluation. PRACTICE IMPLICATIONS Developing guidance by means of a workflow, tools, or questions might support people with chronic conditions and providers to underpin the entire care process with patients' personal goals.
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Affiliation(s)
- Dagje Boeykens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Lara Decoster
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Dorine Lenoir
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Reini Haverals
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Peter Pype
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; End-of-Life Care Research Group, Faculty of Medicine and Health Sciences, VUB and Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, 9000 Ghent, Belgium.
| | - Pauline Boeckxstaens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, 9000 Ghent, Belgium; Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Laarbeeklaan 102, 1050 Brussels, Belgium.
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Boeykens D, Haverals R, Sirimsi MM, Timmermans L, Van de Velde D, De Vriendt P, Boeckxstaens P, Verté E, Van Bogaert P, De Loof H, Van den Broeck K, Anthierens S, Huybrechts I, Raeymaeckers P, Buffel V, Devroey D, Aertgeerts B, Schoenmakers B, Timmermans L, Foulon V, Declerq A, Verhaeghe N, De Sutter A, Lahousse L, Pype P, Van Hecke A, Decat P, Roose R, Martin S, Rutten E, Pless S, Gauwe V, Reynaert D, Van Landschoot L, Hartmann ML, Claeys T, Vandenhoudt H, De Vliegher K. Creating space to talk about patients' personal goals: experiences from primary care stakeholders. BMC PRIMARY CARE 2023; 24:11. [PMID: 36641431 PMCID: PMC9840292 DOI: 10.1186/s12875-022-01956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND To address the many challenges health systems and communities face, primary care is constantly searching for new strategies to improve quality of care. One of the strategies is to focus on patients' personal goals to direct the care process. To adopt an explicit focus on patients' personal goals, actions at different levels are required. As a first step in this process, this study aims to explore the experiences of primary care stakeholders (i.e., scholars, primary care providers, and policy makers) and develop a comprehensive understanding on the idea 'putting patients' goals first'. This will help to formulate suggestions about what these actions should include. METHOD In this study, 41 primary care stakeholders participating in six focus groups between January 2020 and September 2020, were recruited via maximal variation purposive sampling. Data collection was done through an open-ended semi-structured interview guide. Focus groups were audio-recorded, transcribed verbatim, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg. RESULTS All participants expressed a strong fundamental belief for putting patients' personal goals first. The primary care providers shared that they created space for patients' personal goals by letting them talk about their values and stories. They reported to integrate their medical expertise with patients' personal goals in order to develop a balanced relationship. In this context, they also talked about the importance of taking into account the perspectives of patients' significant others. Primary care providers also talked about how they used patients' personal goals as a guide in interprofessional collaboration. Scholars denoted that (future) care providers need more training to acquire competencies to discuss patients' personal goals. The providers and policy makers talked about organizational limitations in terms of time restrictions and the lack of registration systems to support a workflow oriented towards patients' personal goals. CONCLUSIONS This study can be used to support the coherence of the development of different actions and strategies to get primary care stakeholders fully on board to support the adoption of patients' personal goals in care delivery at different levels. However, models of practice and policy plans are needed to work towards a person-centered integrated system.
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Affiliation(s)
- Dagje Boeykens
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Reini Haverals
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Muhammed Mustafa Sirimsi
- grid.5284.b0000 0001 0790 3681Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lotte Timmermans
- grid.5596.f0000 0001 0668 7884Academic Centre of General Practice, KU Leuven, Louvain, Belgium
| | - Dominique Van de Velde
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
| | - Pauline Boeckxstaens
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Tringale M, Stephen G, Boylan AM, Heneghan C. Integrating patient values and preferences in healthcare: a systematic review of qualitative evidence. BMJ Open 2022; 12:e067268. [PMID: 36400731 PMCID: PMC9677014 DOI: 10.1136/bmjopen-2022-067268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To identify and thematically analyse how healthcare professionals (HCPs) integrate patient values and preferences ('values integration') in primary care for adults with non-communicable diseases (NCDs). DESIGN Systematic review and meta-aggregation methods were used for extraction, synthesis and analysis of qualitative evidence. DATA SOURCES Relevant records were sourced using keywords to search 12 databases (ASSIA, CINAHL, DARE, EMBASE, ERIC, Google Scholar, GreyLit, Ovid-MEDLINE, PsycINFO, PubMed-MEDLINE, Scopus and Web of Science). ELIGIBILITY CRITERIA Records needed to be published between 2000 and 2020 and report qualitative methods and findings in English involving HCP participants regarding primary care for adult patients. DATA EXTRACTION AND SYNTHESIS Relevant data including participant quotations, authors' observations, interpretations and conclusions were extracted, synthesised and analysed in a phased approach using a modified version of the Joanna Briggs Institute (JBI) Data Extraction Tool, as well as EPPI Reviewer and NVivo software. The JBI Critical Appraisal Checklist for Qualitative Research was used to assess methodological quality of included records. RESULTS Thirty-one records involving >1032 HCP participants and 1823 HCP-patient encounters were reviewed. Findings included 143 approaches to values integration in clinical care, thematically analysed and synthesised into four themes: (1) approaches of concern; (2) approaches of competence; (3) approaches of communication and (4) approaches of congruence. Confidence in the quality of included records was deemed high. CONCLUSIONS HCPs incorporate patient values and preferences in healthcare through a variety of approaches including showing concern for the patient as a person, demonstrating competence at managing diseases, communicating with patients as partners and tailoring, adjusting and balancing overall care. Themes in this review provide a novel framework for understanding and addressing values integration in clinical care and provide useful insights for policymakers, educators and practitioners. PROSPERO REGISTRATION NUMBER CRD42020166002.
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Affiliation(s)
| | | | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Primary Health Care, University of Oxford, Oxford, UK
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Boeykens D, Boeckxstaens P, De Sutter A, Lahousse L, Pype P, De Vriendt P, Van de Velde D. Goal-oriented care for patients with chronic conditions or multimorbidity in primary care: A scoping review and concept analysis. PLoS One 2022; 17:e0262843. [PMID: 35120137 PMCID: PMC8815876 DOI: 10.1371/journal.pone.0262843] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 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 of 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 as meeting patients' goals could have potential benefits. Though, 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Dagje Boeykens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Pauline Boeckxstaens
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - An De Sutter
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Lies Lahousse
- Faculty of Pharmaceutical Sciences, Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
- Faculty of Medicine and Pharmacy, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
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Alexanders J, Perry J, Douglas C. A THEORETICAL BASED PHYSIOTHERAPY GOAL SETTING MODEL FOR ANTERIOR CRUCIATE LIGAMENT REHABILITATION. Physiother Theory Pract 2021; 38:2330-2338. [PMID: 34587871 DOI: 10.1080/09593985.2021.1983906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anterior Cruciate Ligament rehabilitation is a lengthy process and requires appropriate goal setting strategies to help optimize patient and athlete outcomes. From a global perspective, ACL injury incidences are continuing to rise, with Australia and the USA having one of the highest incidences of ACL injury rates in the athletic population. In addition, physiotherapists are expected by their professional regulatory body to effectively use goal setting practices. DESIGN Theoretical Goal Setting Model consisting of three phases: 1) Pre goal setting phase (empower); 2) goal implementation phase (strive); and 3) goal evaluation phase (attain). DISCUSSION This model provides physiotherapists with a useful process so that key aspects of setting goals are considered and incoporporated. This model showcases a necessary path a physiotherapist and patient must journey together in order to enhance rehabilitation outcomes. This model will also advance the physiotherapists' awareness of the multi-stages of the patients goal desires, intentions and commitment to their rehabilitation. CONCLUSION This model is a preliminary attempt to guide both practice, teaching, and research to ensure that goal setting practices in ACL rehabilitation are given an appropriate rehabilitative platform. The next stage is to empirically validate the practical application of the model and how each phase manifests.
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Affiliation(s)
| | - John Perry
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
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Alexanders J, Perry J, Douglas C. Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training and experiences. Musculoskeletal Care 2021; 19:293-305. [PMID: 33427379 DOI: 10.1002/msc.1535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are a common injury that occurs in both the sporting and non-sporting population. Goal setting is said to be an effective psychological tool within ACL rehabilitation and is commonly used by physiotherapists. To date, literature surrounding goal setting practices is under analysed in relation to qualitative research. PURPOSE The central aim of this study was to explore UK physiotherapists understanding, experiences and training towards goal setting practices used in ACL rehabilitation and whether they are effective. METHOD Semi-structured interviews involving 24 participants across three specific areas including: National Health Service, elite sport and academia were conducted using an inductive approach. Data analysis included thematic analysis with triangulation and a comprehensive multi-staged analysis process to enhance trustworthiness, whilst respecting ethical considerations. RESULTS/DISCUSSION Participants from all three areas of practice tended to use the same approach which was SMART goals. All participants lacked any theoretical understanding of goals but would welcome further training in the field. Participants were missing important aspects of setting goals such as not addressing expectations and underutilising feedback. CONCLUSION These findings suggest that a call for more psychological training is clearly warranted in both the physiotherapy curriculum and within post graduate CPD training. Creating a specialist interest group (e.g. physiotherapists interested in psychology) may help share good psychological practices and overall enhance understanding in this field.
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Affiliation(s)
| | - John Perry
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
| | - Caroline Douglas
- Sport, Health and Exercise Science, University of Hull, Hull, UK
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Ardissone A. From loyalty to resignation: Patient-doctor figurations in type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1388-1404. [PMID: 34050536 PMCID: PMC8453939 DOI: 10.1111/1467-9566.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 04/17/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
This paper contributes to the debate on the patient-doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self-management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational-processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors.
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Rzewuska M, Carolina Guidorizzi Zanetti A, Skea ZC, Moscovici L, Almeida de Oliveira C, Mazzoncini de Azevedo-Marques J. Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers. PLoS One 2021; 16:e0251320. [PMID: 33983998 PMCID: PMC8118469 DOI: 10.1371/journal.pone.0251320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.
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Affiliation(s)
- Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Scotland, United Kingdom
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Zoë C. Skea
- Health Services Research Unit, University of Aberdeen, Scotland, United Kingdom
| | - Leonardo Moscovici
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Primary Health Care, Academic Health Services Complex at Ribeirão Preto Medical School of the São Paulo University, XIII Regional Health Department, Unified Health System, São Paulo State, Brazil
| | - Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - João Mazzoncini de Azevedo-Marques
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Primary Health Care, Academic Health Services Complex at Ribeirão Preto Medical School of the São Paulo University, XIII Regional Health Department, Unified Health System, São Paulo State, Brazil
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Ledford CJW, Fulleborn ST, Jackson JT, Rogers T, Samar H. Dissonance in the discourse of the duration of diabetes: A mixed methods study of patient perceptions and clinical practice. Health Expect 2021; 24:1187-1196. [PMID: 33949058 PMCID: PMC8369085 DOI: 10.1111/hex.13245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
Background Remission of diabetes can be rewarding for patients and physicians, but there is limited study of how patients perceive the timeline of a disease along the continuum of glycaemic control. Objective To explore how patients perceive the timeline of diabetes along the continuum of glycaemic control and their goals of care and to identify whether family physicians communicate the principles of regression and remission of diabetes. Design Mixed methods approach of qualitative semi‐structured interviews with purposive sampling followed by cross‐sectional survey of physicians. Participants Thirty‐three patients living with prediabetes (preDM) or type 2 diabetes mellitus (T2DM) at medical centres in Georgia and Nevada; and 387 family physicians providing primary care within the same health system. Results Patients described two timelines of diabetes: as a lifelong condition or as a condition that can be cured. Patients who perceived a lifelong condition described five treatment goals: reducing glucose‐related laboratory values, losing weight, reducing medication, preventing treatment intensification and avoiding complications. For patients who perceived diabetes as a disease with an end, the goal of care was to achieve normoglycaemia. In response to patient vignettes that described potential cases of remission and regression, 38.2% of physician respondents would still communicate that a patient has preDM and 94.6% would tell the patient that he still had diabetes. Conclusions Most physicians here exhibited reluctance to communicate remission or regression in patient care. Yet, patients describe two different potential timelines, including a subset who expect their diabetes can be ‘cured’. Physicians should incorporate shared decision making to create a shared mental model of diabetes and its potential outcomes with patients. Patient or Public Contribution In this mixed methods study, as patients participated in the qualitative phase of this study, we asked patients to tell us what additional questions we should ask in subsequent interviews. Data from this qualitative phase informed the design and interpretation of the quantitative phase with physician participants.
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Affiliation(s)
- Christy J W Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Jeremy T Jackson
- Military Primary Care Research Network, Department of Family Medicine, Henry M. Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tyler Rogers
- Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Haroon Samar
- Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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