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Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [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: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
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2
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Sales CMD, Ashworth M, Ayis S, Barkham M, Edbrooke-Childs J, Faísca L, Jacob J, Xu D, Cooper M. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. J Clin Psychol 2023; 79:596-621. [PMID: 35194799 DOI: 10.1002/jclp.23319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/07/2022]
Abstract
Idiographic patient-reported outcome measures (I-PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem-based, and seven goal-based, I-PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I-PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient-centered approach. However, there are several challenges for I-PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I-PROM score. Based on the current state of the literature, we recommend that I-PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I-PROM data.
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Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Sciences (FPCEUP), Center for Psychology at the Universidade do Porto (CPUP), University of Porto, Porto, Portugal
| | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Salma Ayis
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Luís Faísca
- FCHS & Center for Research in Health Technologies and Information, Universidade do Algarve, Faro, Portugal
| | - Jenna Jacob
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Dan Xu
- Zhejiang University of Technology, Hangzhou, China
| | - Mick Cooper
- Department of Psychology, University of Roehampton, London, UK
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3
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Parveen A, Parveen S, Noohu MM. Effect of concurrent and multi-component training on balance, fear of falling, and muscle strength in older adults: a review. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Ogbeiwi O. Theoretical frameworks for project goal‐setting: A qualitative case study of an organisational practice in Nigeria. Int J Health Plann Manage 2022; 37:2328-2344. [DOI: 10.1002/hpm.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Osahon Ogbeiwi
- Faculty of Health Studies University of Bradford Bradford UK
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5
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Ethics Education Learning Outcomes for Health Professions Students. JOURNAL OF ACADEMIC ETHICS 2021. [DOI: 10.1007/s10805-021-09433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Jacob J, Costa da Silva L, Sefi A, Edbrooke‐Childs J. Online counselling and goal achievement: Exploring meaningful change and the types of goals progressed by young people. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
| | - Luís Costa da Silva
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
| | | | - Julian Edbrooke‐Childs
- Child Outcomes Research Consortium Anna Freud National Centre for Children and FamiliesThe Kantor Centre of Excellence London UK
- Evidence Based Practice Unit Anna Freud National Centre for Children and Families and University College London London UK
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7
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Exploring the freemium business model for online medical consultation services in China. Inf Process Manag 2021. [DOI: 10.1016/j.ipm.2021.102515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Efficient Clinical Counseling for Sickle Cell Disease. J Natl Med Assoc 2021; 113:382-387. [PMID: 33610309 DOI: 10.1016/j.jnma.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Adherence to national guidelines such as the National Heart Lung and Blood Institute (NHLBI) Expert Panel Report on the Evidence-Based Management of Sickle Cell Disease can be challenging to both the clinician and the patient. Utilizing effective communication strategies with patients and their families can improve clinician/patient relationships, as well as adherence to national guidelines. Aims of this overview are to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
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Bernard L, Ecochard R, Gueyffier F, Letrilliart L. Drug prescription goals in primary care: a cross-sectional study. BMC Health Serv Res 2020; 20:6. [PMID: 31898496 PMCID: PMC6941394 DOI: 10.1186/s12913-019-4870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Care goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement between physicians and patients.
Methods
This was a cross-sectional study conducted by 11 resident trainees acting as observers in 23 general practices. The residents recorded the indication and main physician’s goal for all drugs prescribed during five consultation days in each practice in December 2015, and the main patient’s goal for a sub-sample of consultations. We used an eight-category generic classification of prescription goals, including three specific (mortality, morbidity and cure), three non-specific (symptoms, quality of life, functioning) and two non-specified (other goal, no goal) categories. Analyses were based on a multivariable, multilevel model and on the kappa statistic applied to the sub-sample of consultations.
Results
The sample encompassed 2141 consultations and 5036 drugs. The main physicians’ goal of drug prescriptions was to relieve symptoms (43.3%). The other goals were to decrease the risk of morbidity (22.4%), to cure disease (11.7%), to improve quality of life (10.6%), to decrease the risk of mortality (8.5%) and to improve functioning (1.8%). The choice of a specific goal was more frequent in patients with the following characteristics: over 50 (OR [1.09;1.15]), of male gender (OR [1.09;1.39]), with full financial coverage for a long-term condition (OR [1.47;1.97]), known by the physician (OR [1.19;2.23]), or with a somatic health problem (OR [2.56;4.17]). Cohen’s kappa for drug prescription goals between the patients and the physicians was 0.26 (0.23–0.30).
Conclusions
Physicians’ goals are poorly shared with patients. It remains to be assessed whether it is possible to collect and discuss information on prescription goals on a daily basis.
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Abstract
Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.
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Affiliation(s)
- Amber Comer
- School of Health and Human Sciences, Indiana University, 1050 Wishard Boulevard, RG 3034, Indianapolis, IN 46202, USA
| | - Lyle Fettig
- Division of General Medicine and Geriatrics, Palliative Care, Indiana University School of Medicine, Eskenazi Health, 640 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Alexia M Torke
- Division of General Medicine and Geriatrics, Indiana University School of Medicine, Indiana University Center for Aging Research, Regenstrief Institute, Incorporated, 1101 West 10th Street, Indianapolis, IN 46202, USA.
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De Vito AN, Sawyer RJ, LaRoche A, Arredondo B, Mizuki B, Knoop C. Acceptability and Feasibility of a Multicomponent Telehealth Care Management Program in Older Adults With Advanced Dementia in a Residential Memory Care Unit. Gerontol Geriatr Med 2020; 6:2333721420924988. [PMID: 32577434 PMCID: PMC7288813 DOI: 10.1177/2333721420924988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of the current study was to examine the acceptability and feasibility of
a multicomponent care management program in older adults with advanced dementia
in a long-term memory care unit. Eighteen older adults with moderate to severe
dementia were asked to wear an activity monitor (Fitbit Charge 2 HR) and
participate in a once monthly telehealth intervention via iPads over a 6-month
period. Activity monitor data were used to assess compliance. Acceptability was
assessed through qualitative interviews conducted with the caregiving staff on
the memory unit. The care management program was acceptable to residents and
their caregivers. Results indicated that the care management program is feasible
in older adults with advanced dementia although activity monitor adherence was
better during the day than at night. Telehealth session compliance was excellent
throughout the study. A long-term multicomponent dementia care program is
acceptable and feasible in individuals with advanced dementia. Future studies
should aim to evaluate whether data received from activity monitors can be used
in a dementia care intervention program.
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Affiliation(s)
- Alyssa N De Vito
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - R John Sawyer
- Department of Neurology, Ochsner Medical Center, Jefferson, LA, USA
| | - Ashley LaRoche
- Department of Neurology, Ochsner Medical Center, Jefferson, LA, USA
| | - Beth Arredondo
- Department of Neurology, Ochsner Medical Center, Jefferson, LA, USA
| | - Brian Mizuki
- Department of Neurology, Ochsner Medical Center, Jefferson, LA, USA
| | - Colleen Knoop
- Department of Neurology, Ochsner Medical Center, Jefferson, LA, USA
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12
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Comer AR, Hickman SE, Slaven JE, Monahan PO, Sachs GA, Wocial LD, Burke ES, Torke AM. Assessment of Discordance Between Surrogate Care Goals and Medical Treatment Provided to Older Adults With Serious Illness. JAMA Netw Open 2020; 3:e205179. [PMID: 32427322 PMCID: PMC7237962 DOI: 10.1001/jamanetworkopen.2020.5179] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE An important aspect of high-quality care is ensuring that treatments are in alignment with patient or surrogate decision-maker goals. Treatment discordant with patient goals has been shown to increase medical costs and prolong end-of-life difficulties. OBJECTIVES To evaluate discordance between surrogate decision-maker goals of care and medical orders and treatments provided to hospitalized, incapacitated older patients. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 363 patient-surrogate dyads. Patients were 65 years or older and faced at least 1 major medical decision in the medical and medical intensive care unit services in 3 tertiary care hospitals in an urban Midwestern area. Data were collected from April 27, 2012, through July 10, 2015, and analyzed from October 5, 2018, to December 5, 2019. MAIN OUTCOMES AND MEASURES Each surrogate's preferred goal of care was determined via interview during initial hospitalization and 6 to 8 weeks after discharge. Surrogates were asked to select the goal of care for the patient from 3 options: comfort-focused care, life-sustaining treatment, or an intermediate option. To assess discordance, the preferred goal of care as determined by the surrogate was compared with data from medical record review outlining the medical treatment received during the target hospitalization. RESULTS A total of 363 dyads consisting of patients (223 women [61.4%]; mean [SD] age, 81.8 [8.3] years) and their surrogates (257 women [70.8%]; mean [SD] age, 58.3 [11.2] years) were included in the analysis. One hundred sixty-nine patients (46.6%) received at least 1 medical treatment discordant from their surrogate's identified goals of care. The most common type of discordance involved full-code orders for patients with a goal of comfort (n = 41) or an intermediate option (n = 93). More frequent in-person contact between surrogate and patient (adjusted odds ratio [AOR], 0.43; 95% CI, 0.23-0.82), patient residence in an institution (AOR, 0.44; 95% CI, 0.23-0.82), and surrogate-rated quality of communication (AOR, 0.98; 95% CI, 0.96-0.99) were associated with lower discordance. Surrogate marital status (AOR for single vs married, 1.92; 95% CI, 1.01-3.66), number of family members involved in decisions (AOR for ≥2 vs 0-1, 1.84; 95% CI, 1.05-3.21), and religious affiliation (AOR for none vs any, 4.87; 95% CI, 1.12-21.09) were associated with higher discordance. CONCLUSIONS AND RELEVANCE This study found that discordance between surrogate goals of care and medical treatments for hospitalized, incapacitated patients was common. Communication quality is a modifiable factor associated with discordance that may be an avenue for future interventions.
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Affiliation(s)
- Amber R. Comer
- Department of Health Sciences, Indiana University School of Health and Human Sciences, Indianapolis
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis
- Indiana University Purdue University Indianapolis Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, School of Nursing, Indiana University, Indianapolis
| | - Susan E. Hickman
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis
- Indiana University Purdue University Indianapolis Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, School of Nursing, Indiana University, Indianapolis
- Department of Community and Health Systems, School of Nursing, Indiana University, Indianapolis, Indiana
- Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis
| | - James E. Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick O. Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Greg A. Sachs
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis
- Indiana University Purdue University Indianapolis Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, School of Nursing, Indiana University, Indianapolis
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis
| | - Lucia D. Wocial
- Indiana University Purdue University Indianapolis Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, School of Nursing, Indiana University, Indianapolis
- Department of Community and Health Systems, School of Nursing, Indiana University, Indianapolis, Indiana
- Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis
| | - Emily S. Burke
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis
| | - Alexia M. Torke
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis
- Indiana University Purdue University Indianapolis Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, School of Nursing, Indiana University, Indianapolis
- Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis
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13
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Erlandson KM, Karris MY. HIV and Aging: Reconsidering the Approach to Management of Comorbidities. Infect Dis Clin North Am 2019; 33:769-786. [PMID: 31395144 PMCID: PMC6690376 DOI: 10.1016/j.idc.2019.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Health care for older adults with human immunodeficiency virus can be highly complex, resource intensive, and carry a high administrative burden. Data from aging longitudinal cohorts and feedback from the human immunodeficiency virus community suggest that the current model is not meeting the needs of these older adults. We introduce the 6 Ms approach, which acknowledges the multicomplexity of older adults with human immunodeficiency virus, simplifies geriatric principles for non-geriatrics-trained providers, and minimizes extensive training and specialized screening tests or tools. Implementing novel approaches to care requires support at local/national levels.
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Affiliation(s)
- Kristine M Erlandson
- University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA.
| | - Maile Y Karris
- University of California San Diego, 200 West Arbor Drive #8208, San Diego, CA 92103-8208, USA
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14
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Monga V, Maliske SM, Kaleem H, Mott SL, K D Zamba G, Milhem M. Discrepancy between treatment goals documentation by oncologists and their understanding among cancer patients under active treatment with chemotherapy. Eur J Cancer Care (Engl) 2018; 28:e12973. [PMID: 30511450 DOI: 10.1111/ecc.12973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 08/09/2018] [Accepted: 10/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND Discussion of treatment goals between oncologists and patients is challenging. Patients frequently misunderstand goals of therapy. There are several methods to document goals of chemotherapy, however, and are frequently not incorporated into patient charts. METHODS/DESIGN Cancer patients receiving their first cycle of chemotherapy were interviewed. Patients' recall of discussions with their oncologist regarding therapy intent was assessed and compared to documentation. An adjusted McNemar's test was utilised. A one-sample proportion test was used to evaluate whether the overall observed rate of discordance was significantly different from the proposed 33% rate; a rate posited as a threshold too high in the clinical sense. RESULTS Two hundred and seven eligible patients were interviewed. Oncologist identified treatment goals were not documented in 24.6% of cases and had to be excluded. There was not a significant difference in the directionality of discordance present. Inter-rater agreement between patient and oncologist was found to be adequate (κ = 0.64). The overall rate of discordance (17.29%) was found to be significantly less than the proposed acceptable level of 33% (p < 0.01). Upon univariable analysis, age, gender, marital and employment status were not found to be associated with discordance. CONCLUSIONS Discordance between treatment goals documentation and their understanding exists, indicating continued miscommunication between the patient and oncologist.
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Affiliation(s)
- Varun Monga
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Seth M Maliske
- Aspirus Wausau Hospital Regional Cancer Center, Wausau, Wisconsin
| | - Hassan Kaleem
- Division of Hematology and Oncology, Texas Tech University, Lubbock, Texas
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Gideon K D Zamba
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Mohammed Milhem
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Ouellet GM, Ouellet JA, Tinetti ME. Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions. Ther Adv Drug Saf 2018; 9:639-652. [PMID: 30479739 PMCID: PMC6243421 DOI: 10.1177/2042098618791371] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022] Open
Abstract
Although the majority of older adults in the developed world live with multiple chronic conditions (MCCs), the task of selecting optimal treatment regimens is still fraught with difficulty. Older adults with MCCs may derive less benefit from prescribed medications than healthier patients as a result of the competing risk of several possible outcomes including, but not limited to, death before a benefit can be accrued. In addition, these patients may be at increased risk of medication-related harms in the form of adverse effects and significant burdens of treatment. At present, the balance of these benefits and harms is often uncertain, given that older adults with MCCs are often excluded from clinical trials. In this review, we propose a framework to consider patients' own priorities to achieve optimal treatment regimens. To begin, the practicing clinician needs information on the patient's goals, what the patient is willing and able to do to achieve these goals, an estimate of the patient's clinical trajectory, and what the patient is actually taking. We then describe how to integrate this information to understand what matters most to the patient in the context of an array of potential tradeoffs. Finally, we propose conducting serial therapeutic trials of prescribing and deprescribing, with success measured as progress towards the patient's own health outcome goals. The process described in this manuscript is truly an iterative process, which should be repeated regularly to account for changes in the patient's priorities and clinical status. With this process, we aim to achieve optimal prescribing, that is, treatment regimens that maximize benefits that matter to the patient and minimize burdens and potential harms.
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Affiliation(s)
- Gregory M. Ouellet
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness A, Room 308-A, New Haven, CT 06520-8093, USA
| | - Jennifer A. Ouellet
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mary E. Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Holden TR, Shah MN, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Outcomes of Patients With Syncope and Suspected Dementia. Acad Emerg Med 2018; 25:880-890. [PMID: 29575587 PMCID: PMC6156993 DOI: 10.1111/acem.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
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Affiliation(s)
- Timothy R. Holden
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tommy A. Gibson
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - David H. Adler
- Department of Emergency Medicine, University of Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
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17
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General concepts of goals and goal-setting in healthcare: A narrative review. JOURNAL OF MANAGEMENT & ORGANIZATION 2018. [DOI: 10.1017/jmo.2018.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractGoal-setting is fundamental to organisational management, yet not every manager knows how to do it well. A narrative literature review was done to explore current knowledge of definitions and classifications of goals, and principles of goal-setting in the healthcare sector. Online databases generated 65 relevant articles. Additional literature sources were snowballed from referenced articles, and textbooks. Most academic authors define ‘goal’ synonymously as ‘aim’ or ‘objective’, but there is evidence of hermeneutical confusion in general literature. Goal classifications are diverse, differing according to their contextual, structural, functional, and temporal characteristics. Many authors agree that goal-setting is problem-based, change-oriented, and can effectively motivate attainment if the goal statement is formulated with a specific and challenging or SMART framework. However, recent authors report varying definitions for SMART, and evidence of past studies that empirically examined the nature and efficacy of frameworks currently used for formulating goal statements for health programmes are lacking.
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Etkind SN, Bone AE, Lovell N, Higginson IJ, Murtagh FEM. Influences on Care Preferences of Older People with Advanced Illness: A Systematic Review and Thematic Synthesis. J Am Geriatr Soc 2018; 66:1031-1039. [PMID: 29512147 PMCID: PMC6001783 DOI: 10.1111/jgs.15272] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives To determine and explore the influences on care preferences of older people with advanced illness and integrate our results into a model to guide practice and research. Design Systematic review using Medline, Embase, PsychINFO, Web of Science, and OpenGrey databases from inception to February 2017 and reference and citation list searching. Included articles investigated influences on care preference using qualitative or quantitative methodology. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were undertaken. Setting Hospital and community care settings. Participants Older adults with advanced illness, including people with specific illnesses and markers of advanced disease, populations identified as in the last year of life, or individuals receiving palliative care (N = 15,164). Measurements The QualSys criteria were used to assess study quality. Results Of 12,142 search results, 57 articles were included. Family and care context, illness, and individual factors interact to influence care preferences. Support from and burden on family and loved ones were prominent influences on care preferences. Mechanisms by which preferences are influenced include the process of trading‐off between competing priorities, making choices based on expected outcome, level of engagement, and individual ability to form and express preferences. Conclusion Family is particularly important as an influence on care preferences, which are influenced by complex interaction of family, individual, and illness factors. To support preferences, clinicians should consider older people with illnesses and their families together as a unit of care.
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Affiliation(s)
- Simon N Etkind
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Natasha Lovell
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Schulkes KJG, Hamaker ME, Lammers JWJ, van Rens MTM, Geerts M, van Elden LJR. Multidisciplinary decision-making regarding chemotherapy for lung cancer patients-An age-based comparison. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28940851 DOI: 10.1111/ecc.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Abstract
Optimising decision-making in elderly patients is becoming increasingly urgent. We analysed treatment decisions and course of therapy for patients with lung cancer in different age categories: <65, 65-75, and 75 years and older. About 349 patients with lung cancer (median age 67.8 years), discussed at the multidisciplinary team meeting in the Diakonessenhuis Utrecht, the Netherlands, were reviewed. Multidisciplinary decision-making and subsequent clinical course were extracted from medical files. We found that 39% of eligible patients older than 75 years of age started treatment with chemotherapy compared to 80% of the younger patients (<65 and 65-75). When patients did receive chemotherapy, primary and secondary treatment adaptations were effectuated in 58%: for patients aged <65 in 49%, for patients aged 65-75 and >75 years in 66%. For 44% of all patients treated with chemotherapy, unplanned hospital admissions were required: in 42% for the patients <65, in 52% for those aged 65-75 and in 27% for >75 years. The decision-making process and course of treatment for lung cancer vary per age category. In particular, patients between 65 and 75 years of age might be more frail than initially thought. Age and frailty are important characteristics that need more attention.
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Affiliation(s)
- K J G Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - J-W J Lammers
- Department of Pulmonology, UMC Utrecht, Utrecht, The Netherlands
| | - M T M van Rens
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M Geerts
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - L J R van Elden
- Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Coleman EA, Min SJ. Patients' and Family Caregivers' Goals for Care During Transitions Out of the Hospital. Home Health Care Serv Q 2017; 34:173-84. [PMID: 26496503 DOI: 10.1080/01621424.2015.1095149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aims of this study were to (a) describe the nature of patients' goals upon discharge from hospital, family caregivers' goals for their loved ones, and family caregivers' goals for themselves; (b) determine the degree of concordance with respect to the three elicited goals; (c) ascertain goal attainment across the three elicited goals; and (d) examine factors predictive of goal attainment. Our findings support the position that eliciting patient and family caregiver goals and promoting goal attainment may represent an important step toward promoting greater patient and family caregiver engagement in their care.
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Affiliation(s)
- Eric A Coleman
- a Division of Health Care Policy and Research , University of Colorado Denver Anschutz Medical Campus , Aurora , Colorado , USA
| | - Sung-Joon Min
- a Division of Health Care Policy and Research , University of Colorado Denver Anschutz Medical Campus , Aurora , Colorado , USA
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21
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Emerging therapies for pre-RA. Best Pract Res Clin Rheumatol 2017; 31:99-111. [DOI: 10.1016/j.berh.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/07/2017] [Indexed: 01/20/2023]
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Naik AD, Martin LA, Moye J, Karel MJ. Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness. J Am Geriatr Soc 2016; 64:625-31. [PMID: 27000335 DOI: 10.1111/jgs.14027] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify a taxonomy of health-related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment. DESIGN Qualitative analysis of data from a longitudinal cohort study of multimorbid cancer survivors. SETTING Cancer registries from regional Department of Veterans Affairs networks in New England and southeast Texas. PARTICIPANTS Multimorbid adults who completed interviews 12 months after diagnosis of head and neck, colorectal, gastric, or esophageal cancer and after cancer treatment (N = 146). MEASUREMENTS An interdisciplinary team conducted thematic analyses of participants' intuitive responses to two questions: Now that you have had cancer and may face ongoing decisions about medical care in the future, what would you want your family, friends, and doctors to know about you, in terms of what is most important to you in your life? If your cancer were to recur, is there anything you'd want to be sure your loved ones knew about you and your goals of care? RESULTS Analysis revealed five distinct health-related values that guide how multimorbid cancer survivors conceptualize specific health care goals and medical decisions: self-sufficiency, life enjoyment, connectedness and legacy, balancing quality and length of life, and engagement in care. Participants typically endorsed more than one value as important. CONCLUSION Older multimorbid adults who recently faced life-threatening cancer endorsed a multidimensional taxonomy of health-related values. These health-related values guide how they frame their goals for care and treatment preferences. Eliciting individuals' sense of their values during clinical encounters may improve their experiences with health care and more effectively align treatments with goals of care.
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Affiliation(s)
- Aanand D Naik
- Center of Innovations in Quality, Effectiveness, and Safety, Houston Veterans Affairs Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Veterans Affairs Quality Scholars Program Coordinating Center, Houston, Texas
| | - Lindsey A Martin
- Center of Innovations in Quality, Effectiveness, and Safety, Houston Veterans Affairs Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jennifer Moye
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Michele J Karel
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Taylor SD, Bagozzi RP, Gaither CA, Jamerson KA. The Bases of Goal Setting in the Self-regulation of Hypertension. J Health Psychol 2016; 11:141-62. [PMID: 16314387 DOI: 10.1177/1359105306058869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We apply a new methodology to investigate goal setting by hypertensive patients that uncovers the reasons why people have a goal to manage hypertension or not (e.g. to reduce/maintain one’s current blood pressure). The reasons are found to consist of superordinate goals in support of one’s focal hypertension goal and the hierarchical mental network underlying the superordinate goals. We show that, not only do such superordinate goals influence patients’ beliefs, feelings and decisions, but the relationships among superordinate goals are particularly efficacious in the formation of beliefs and attitudes, as well as intentions to self-regulate hypertension and actual efforts in doing so. Hypotheses were tested on a sample of 219 patients at a university-based hypertension clinic.
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Patient-Centered Outcome Measures in Lung Cancer Trials. Lung 2016; 194:647-52. [PMID: 27287676 DOI: 10.1007/s00408-016-9903-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Scientific communities focusing on cancer research have urged for the development of trials that address patient-centered outcome measures instead of solely focusing on cancer as a disease-centered process. This is important for a patient with lung cancer because of the rapid course of disease and generally poor prognosis. We set out to determine the characteristics and study objectives of the current clinical trials in pulmonary malignancies. METHODS The United States National Institutes of Health clinical trial registry was searched on April 23rd 2015, for currently recruiting phase I, II, or III clinical trials in lung cancer. Trial characteristics and study objectives were extracted from the registry website. RESULTS Of the 419 clinical trials included in this review, patient-centered outcome measures are investigated in a minority of the trials. Outcome measures as quality of life, functional capacity, and health care utilization are included in a small number of trials (20, 4, and 2 % respectively). Treatment completion is included in 1 % of the trials. Research goals are most frequently toxicity (78 %) and progression-free survival (76 %). CONCLUSION Patient-centered outcome measures are included in a minority of the currently recruiting clinical trials in pulmonary malignancies. If we do not investigate these outcome measures, it is not possible to increase our knowledge of the optimal treatment, as this should aim to optimize the patient's wellbeing as well as the course of disease. One option could be to incorporate combinations of patient- and disease-centered endpoints, for instance by using overall treatment utility or quality-adjusted outcome measures.
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Tichelaar J, Uil den SH, Antonini NF, van Agtmael MA, de Vries TPGM, Richir MC. A 'SMART' way to determine treatment goals in pharmacotherapy education. Br J Clin Pharmacol 2016; 82:280-4. [PMID: 26914983 DOI: 10.1111/bcp.12919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/31/2016] [Accepted: 02/17/2016] [Indexed: 11/29/2022] Open
Abstract
AIM Determining treatment goals is an important part of the treatment decision-making process, but medical students are not trained in a structural way on how to define these goals. 'SMART' criteria are widely used in non-medical professions for determining goals and may improve treatment goal setting. The aim of this study was to assess the effect of implementation of SMART criteria on medical students' ability to set treatment goals and to analyze the effects on treatment choice and monitoring. METHODS We performed a prospective, randomized controlled minimal intervention study with one control and two intervention groups (WHO group and SMART group). Second year medical students had to complete a WHO six step treatment plan for four written case reports of patients with asthma. The treatment plans were assessed using a standard scoring sheet developed by a Delphi procedure among respiratory physicians from all eight university medical centres in the Netherlands. RESULTS A total of 251 second year medical students participated. The SMART group had significantly higher scores for setting treatment goals than the WHO and control groups (68.5 % vs. 29.6 % and 30.8 %, respectively, both P < 0.001). The SMART group also had significantly better scores for treatment monitoring than the WHO and control groups (34.2 % vs. 19.3 % and 24.6 %, respectively, both P < 0.001). There were no between group differences in treatment choice. Regardless of the study group, better setting of treatment goals was associated with better treatment monitoring, an association not reported earlier. CONCLUSION SMART criteria improve the setting of treatment goals and treatment monitoring.
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Affiliation(s)
- Jelle Tichelaar
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Sjoerd H Uil den
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Ninja F Antonini
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel A van Agtmael
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Theo P G M de Vries
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Milan C Richir
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
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26
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Rand KL, Banno DA, Shea AM, Cripe LD. Life and treatment goals of patients with advanced, incurable cancer. Support Care Cancer 2016; 24:2953-62. [PMID: 26864986 DOI: 10.1007/s00520-016-3113-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment. METHODS Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N = 84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N = 63), eliciting life and treatment goals, values, and expectancies. RESULTS Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M = 1.46 vs. 0.78) and more depressive symptoms (M = 6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M = 69.23 % vs. 86.11 %), fewer treatment goals (M = 2.08 vs. 3.16), and lower optimism (M = 15.00 vs. 18.32). CONCLUSIONS Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.
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Affiliation(s)
- Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA. .,Indiana University Simon Cancer Center, Indianapolis, IN, USA. .,Walther Program in Palliative Care Research, Indianapolis, IN, USA. .,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA.
| | - Daniella A Banno
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Amanda M Shea
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Larry D Cripe
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA.,Walther Program in Palliative Care Research, Indianapolis, IN, USA.,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA
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27
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Patient-relevant needs and treatment goals in nail psoriasis. Qual Life Res 2015; 25:1179-88. [DOI: 10.1007/s11136-015-1136-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
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van Unen RJ, Tichelaar J, Nanayakkara PWB, van Agtmael MA, Richir MC, de Vries TPGM. A Delphi study among internal medicine clinicians to determine which therapeutic information is essential to record in a medical record. J Clin Pharmacol 2015; 55:1415-21. [PMID: 26096268 DOI: 10.1002/jcph.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/05/2015] [Indexed: 11/08/2022]
Abstract
Several studies have demonstrated that using a template for recording general and diagnostic information in the medical record (MR) improves the completeness of MR documentation, communication between doctors, and performance of doctors. However, little is known about how therapeutic information should be structured in the MR. The aim of this study was to investigate which specific therapeutic information registrars and consultants in internal medicine consider essential to record in the MR. Therefore, we carried out a 2-round Internet Delphi study. Fifty-nine items were assessed on a 5-point scale; an item was considered important if ≥ 80% of the respondents awarded it a score of 4 or 5. In total, 26 registrars and 30 consultants in internal medicine completed both rounds of the study. Overall, they considered it essential to include information about 11 items in the MR. Subgroup analyses revealed that the registrars considered 8 additional items essential, whereas the consultants considered 1 additional item essential to record. Study findings can be used as a starting point to develop a structured section of the MR for therapeutic information for both paper and electronic MRs. This section should contain at least 11 items considered essential by registrars and clinical consultants in internal medicine.
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Affiliation(s)
- Robert J van Unen
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Tichelaar
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Michiel A van Agtmael
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Milan C Richir
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Theo P G M de Vries
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
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Boa S, Duncan EAS, Haraldsdottir E, Wyke S. Goal setting in palliative care: A structured review. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tang Yan HS, Clemson LM, Jarvis F, Laver K. Goal setting with caregivers of adults in the community: a mixed methods systematic review. Disabil Rehabil 2014; 36:1943-63. [PMID: 24856636 DOI: 10.3109/09638288.2014.884173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine how goal setting is used with caregivers of community residing adults and the effect of goal setting practices in improving the outcomes. METHODS A mixed methods systematic review was conducted. The methodological rigour of included studies was critiqued using Cochrane Collaboration's risk of bias assessment tool, Downs and Black checklist and a framework for evaluating qualitative research. Narrative synthesis was created through tabulation and categorisation, visual mapping of the goal setting process, thematic analysis on common goal setting features and critical reflection on the accuracy and robustness of the synthesis. RESULTS Seventeen studies were included: 10 randomised trials, 5 other quantitative studies and two descriptive studies which incorporated qualitative methods. The trials demonstrated a relatively low risk of bias in contrast to the other studies that had varied methodological rigour. No studies isolated the effect of the goal setting process on outcomes and therefore the effectiveness of goal setting could not be evaluated. However, through a narrative synthesis six prominent features of collaborative goal setting were identified. CONCLUSIONS Despite the fact that goal setting is an important component of client-centred care, and the prominence of client-centred care in healthcare discourse, the review uncovered a surprisingly limited number of studies. Goal setting is an elusive process that is of therapeutic value and warrants further investigation. Implications for Rehabilitation The current body of empirical evidence suggests that there are six prominent features of collaborative goal setting with caregivers. The goals that are most important to caregivers are often different to those that are important to clinicians; it is important that caregivers and clinicians agree on goals to maximise adherence to treatment and goal attainment. The quality of evidence for goal setting with caregivers is limited although some intervention trials illustrate the usefulness of collaborative goal setting in contributing to improved outcomes.
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Affiliation(s)
- Heidi Shaunna Tang Yan
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney , Lidcombe, NSW , Australia and
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Parsons JGM, Parsons MJG. The effect of a designated tool on person-centred goal identification and service planning among older people receiving homecare in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:653-62. [PMID: 22812380 DOI: 10.1111/j.1365-2524.2012.01081.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study sought to determine the ability of a designated tool developed to identify client-directed goals in a sample of older people referred for homecare. A retrospective pre/post-intervention design was used and a total of 360 older people in an urban centre in New Zealand were included in the analysis. All clients receiving services at the time of data collection (July 2007) who were referred for service provision between July 2003 and the implementation in January 2007 of a restorative model of homecare were included in the analysis. The restorative model of homecare included a designated goal-facilitation tool [Towards Achieving Realistic Goal in Elders Tool (TARGET)]. Prior to the use of TARGET, participants had a goal recorded for their home-care episode in 31 cases (8.6%), whereas following the implementation of TARGET, goals were recorded in 339 cases (94.2%). At a quarterly review, eight clients (2.2%) achieved their goal prior to TARGET, whereas 172 clients (47.8%) fully achieved their goal when TARGET was utilised. Within the sample, multinomial logistic regression showed that the use of TARGET significantly improved goal attainment. Furthermore, moderate-to-severe cognitive impairment significantly reduced the successful attainment of goals. The study highlighted the importance of a designated tool for facilitating older people to set goals that are then used in developing support plans to structure services to assist them in the home. The need for alternative strategies for goal setting for people with significant cognitive impairment was highlighted. This study, in attempting to determine the effect of a goal-facilitation tool as a driver for quality improvement in homecare, had an observational comparative design, this being the most pragmatic option to assess the feasibility of TARGET prior to further work being undertaken. The results do show that in this sample of older people receiving homecare, the use of TARGET led to a greater proportion of goal identification, higher rates of goal attainment and a more diverse range of categories of goals than traditional non-structured methods of goal setting.
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Affiliation(s)
- John G M Parsons
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Transitioning from active treatment: colorectal cancer survivors' health promotion goals. Palliat Support Care 2012; 11:101-9. [PMID: 23089464 DOI: 10.1017/s1478951512000788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study is to describe the post-treatment goals of colorectal cancer (CRC) survivors. We sought to determine whether goals were a salient concept during the period immediately following treatment, and whether a goal-setting intervention might be feasible and acceptable to these patients. METHOD Semi-structured qualitative interviews were administered to a convenience sample of 41 CRC patients who were 0-24 months post-treatment. Topics discussed included expectations and goals for future health, cancer prevention awareness, health-promoting behavior-change goals, and post-treatment cancer issues. Content analysis was used to explore emergent themes. RESULTS Overall, participants' health-related goals were: being healthy, getting back to normal, and not having a cancer recurrence. Most of the CRC survivors reported being proactive with their health by maintaining healthy behaviors or making healthy behavior changes, or had goals to change their behavior. All respondents had plans to maintain follow-up care and regular screening appointments. Some patients were managing treatment side effects or non-cancer issues that limited their functional abilities. Many respondents were satisfied with the care they received, and felt it was now their responsibility to do their part in taking care of themselves. SIGNIFICANCE OF RESULTS CRC survivors talk about goals, and many of them are either making or have an interest in making health behavior changes. Self-management support could be an appropriate strategy to assist patients with achieving their health goals post-treatment. Patients may need help addressing lingering treatment side effects or non-cancer issues. Healthcare providers should consider assessing patients' goals to help patients resolve post-treatment issues and promote healthy behaviors.
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Howe T, Davidson B, Worrall L, Hersh D, Ferguson A, Sherratt S, Gilbert J. 'You needed to rehab … families as well': family members' own goals for aphasia rehabilitation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:511-21. [PMID: 22938062 DOI: 10.1111/j.1460-6984.2012.00159.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Aphasia affects family members in addition to the individuals with the communication disorder. In order to develop appropriate services for the relatives of people with aphasia post-stroke, their rehabilitation goals need to be identified. AIM The aim of the current investigation was to identify the rehabilitation goals that family members of individuals with aphasia have for themselves. METHODS & PROCEDURES Forty-eight family members of adults with aphasia post-stroke participated in in-depth semi-structured interviews to identify the rehabilitation goals they had for themselves. All the interviews were transcribed verbatim and analysed using qualitative content analysis. OUTCOMES & RESULTS Analysis revealed seven categories of goals that the family members had for themselves: to be included in rehabilitation, to be provided with hope and positivity, to be able to communicate and maintain their relationship with the person with aphasia, to be given information, to be given support, to look after their own well-being, and to be able to cope with new responsibilities. A few participants reported that, at certain times during the rehabilitation process, they did not have any goals for themselves. CONCLUSIONS & IMPLICATIONS This study highlights that family members of individuals with aphasia have a number of aphasia-related rehabilitation goals for themselves. In order to provide a family-centred approach to rehabilitation, health professionals, including speech-language pathologists, need systematically to identify and address family members' goals in light of the categories revealed in this investigation.
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Affiliation(s)
- Tami Howe
- University of Canterbury, Christchurch, New Zealand.
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Tinetti ME, Charpentier P, Gottschalk M, Baker DI. Effect of a restorative model of posthospital home care on hospital readmissions. J Am Geriatr Soc 2012; 60:1521-6. [PMID: 22860756 DOI: 10.1111/j.1532-5415.2012.04060.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care. DESIGN Quasiexperimental; matched and unmatched. SETTING Community, home care. PARTICIPANTS Seven hundred seventy individuals receiving care from a large home care agency after hospitalization. INTERVENTION A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory. MEASUREMENTS Hospital readmission, length of home care episode. RESULTS Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43-1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses. CONCLUSION Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.
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Affiliation(s)
- Mary E Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut 06520, USA.
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Murphy J, Boa S. Using the WHO-ICF with talking mats to enable adults with long-term communication difficulties to participate in goal setting. Augment Altern Commun 2012; 28:52-60. [PMID: 22364538 DOI: 10.3109/07434618.2011.653828] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) provides a framework that helps rehabilitation staff to take a holistic view of the patient. However, it is used predominantly by professionals rather than by active participation on behalf of the person with the disability. In addition, the language used within the framework can be difficult for patients to understand. In order to address these issues the Activities and Participation section of the ICF has been adapted by using graphic symbols. It has been used in conjunction with Talking Mats(™ 1 ), a low-tech communication framework, to help adults with long-term conditions participate in goal setting. This paper describes how this was done and provides examples from clinical practice. The paper discusses how this combined framework can empower people with communication difficulties and long-term conditions to become active participants in the rehabilitation process by identifying their own goals, indicating changing priorities and tracking their progress.
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Affiliation(s)
- Joan Murphy
- Talking Mats Centre, University of Stirling , UK
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Kaldjian LC, Gehlbach TG, Thomas KW, Schmidt GA. The Language of Goals of Care: Response. Chest 2012. [DOI: 10.1378/chest.11-3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gehlbach TG, Shinkunas LA, Forman-Hoffman VL, Thomas KW, Schmidt GA, Kaldjian LC. Code status orders and goals of care in the medical ICU. Chest 2011; 139:802-809. [PMID: 21292755 PMCID: PMC3198491 DOI: 10.1378/chest.10-1798] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/02/2010] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Decisions about CPR in the medical ICU (MICU) are important. However, discussions about CPR (code status discussions) can be challenging and may be incomplete if they do not address goals of care. METHODS We interviewed 100 patients, or their surrogates, and their physicians in an MICU. We queried the patients/surrogates on their knowledge of CPR, code status preferences, and goals of care; we queried MICU physicians about goals of care and treatment plans. Medical records were reviewed for clinical information and code status orders. RESULTS Fifty patients/surrogates recalled discussing CPR preferences with a physician, and 51 recalled discussing goals of care. Eighty-three patients/surrogates preferred full code status, but only four could identify the three main components of in-hospital CPR (defibrillation, chest compressions, intubation). There were 16 discrepancies between code status preferences expressed during the interview and code status orders in the medical record. Respondents' average prediction of survival following in-hospital cardiac arrest with CPR was 71.8%, and the higher the prediction of survival, the greater the frequency of preference for full code status (P = .012). Of six possible goals of care, approximately five were affirmed by each patient/surrogate and physician, but 67.7% of patients/surrogates differed with their physicians about the most important goal of care. CONCLUSIONS Patients in the MICU and their surrogates have inadequate knowledge about in-hospital CPR and its likelihood of success, patients' code status preferences may not always be reflected in code status orders, and assessments may differ between patients/surrogates and physicians about what goal of care is most important.
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Affiliation(s)
- Thomas G Gehlbach
- Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Valerie L Forman-Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Karl W Thomas
- Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Gregory A Schmidt
- Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Lauris C Kaldjian
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA; Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
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Williams B, Steven K, Sullivan FM. Tacit and transitionary: an exploration of patients' and primary care health professionals' goals in relation to asthma. Soc Sci Med 2011; 72:1359-66. [PMID: 21458126 DOI: 10.1016/j.socscimed.2011.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 02/17/2011] [Accepted: 02/17/2011] [Indexed: 01/24/2023]
Abstract
Goal setting is recommended in UK health policy to make health care more patient-centred, to enhance the likelihood of behaviour change and to improve health outcomes. Patient-centred care is thought to be particularly important in the management of long term conditions such as asthma. We therefore explored and compared the asthma goals of both health professionals and people with asthma within the primary care clinical consultation, and identified the potential barriers to achieving shared goals and more patient-centred care provision. We conducted a qualitative study based on semi-structured interviews with 15 people with asthma, 7 general practitioners and 6 primary care asthma nurses from Tayside, UK. The data were analysed using the 'Framework' methodology. Four potential barriers to the identification of goals were located. The first stemmed from the status and nature of patients' goals, while the remaining three related to the beliefs and practices of health professionals. These findings are discussed in relation to relevant sociological literature around the potential tensions between lay and professional knowledge, and also tensions in the relationship between knowledge and values. We conclude that barriers need to be recognised and addressed where possible before the achievement of shared asthma goals can become common practice. In particular, health professionals may require training in how to elicit goals with patients and how to differentiate between end states and goals that are in fact assumed to mediate the achievement of such desired end states.
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Kaldjian LC, Broderick A. Developing a Policy for Do Not Resuscitate Orders Within a Framework of Goals of Care. Jt Comm J Qual Patient Saf 2011; 37:11-9. [DOI: 10.1016/s1553-7250(11)37002-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Haberle TH, Shinkunas LA, Erekson ZD, Kaldjian LC. Goals of Care among Hospitalized Patients: A Validation Study. Am J Hosp Palliat Care 2010; 28:335-41. [DOI: 10.1177/1049909110388505] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our objective was to validate 6 literature-derived goals of care by analyzing open-ended and closed-ended responses about goals of care from a previous study of hospitalized patients. Eight clinicians categorized patients’ open-ended articulations of their goals of care using a literature-derived framework and then compared those categorizations to patients’ own closed-ended selections of their most important goal of care. Clinicians successfully categorized patients’ open-ended responses using the literature-derived framework 83.5% of the time, and their categorizations matched patients’ closed-ended most important goal of care 87.8% of the time. Goals that did not fit within the literature-derived framework all pertained to the goal of understanding a patient’s diagnosis or prognosis; this seventh potential goal can be added to the literature-derived framework of 6 goals of care.
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Affiliation(s)
- Tyler H. Haberle
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Laura A. Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Zachary D. Erekson
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Lauris C. Kaldjian
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA, , Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev 2010; 9 Suppl 1:S18-22. [PMID: 20849981 DOI: 10.1016/j.arr.2010.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/13/2010] [Indexed: 11/25/2022]
Abstract
The prevalence and incidence of type 2 diabetes mellitus (DM) increase with age, and its diagnosis and treatment in older people present a challenge. Applying evidence to elderly patients can be problematic, because older persons with frailty, multiple comorbidities, and functional disabilities are generally excluded from diabetes clinical trials. Frailty is characterized by multisystem decline and vulnerability to adverse health outcomes. Insulin resistance predicts frailty, and DM accelerates muscle strength loss. Geriatric diabetes care guidelines have refocused from risk factor control to geriatric syndromes. The European Diabetes Working Party guidelines for elderly type 2 DM patients consider frailty, recommending a conservative target (hemoglobin A1c <8%). Diabetic care-home residents with physical disabilities, cognitive impairment, tube feeding, and the inability to communicate pose particular challenges. Tight glycemic control for such patients increases the risk of hypoglycemia and significant functional decline; a mean hemoglobin A1c <7% did not protect them from care-home-acquired pneumonia. In conclusion, caring for elderly diabetic patients poses unique challenges. Little is known about diabetes care of elderly people with frailty, disabilities, or multiple comorbidities. The interrelationship between frailty and DM deserves further investigation. Practice guidelines for care-home residents with DM are needed to ensure quality of care.
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Manderson L, Warren N. The art of (re)learning to walk: trust on the rehabilitation ward. QUALITATIVE HEALTH RESEARCH 2010; 20:1418-1432. [PMID: 20555012 DOI: 10.1177/1049732310373105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although trust has significant implications for health outcomes, the mechanisms by which its presence or absence influences these outcomes require elucidation. Drawing on ethnographic research conducted in southeast Australia, we explore the tasks of rehabilitation for people who lost a limb because of vascular disease, and the importance of trust in the relationships of patients with their health professionals. Trust underpins procedures and practices designed to minimize problems that might delay rehabilitation or result in the continuing need for medical support and surveillance. Patients develop trust in the rehabilitation team based on three factors: competence, agency, and caring. Our findings emphasize how social skills, as well as technical competence, enable health professionals to gain and maintain their patients' trust.
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Affiliation(s)
- Lenore Manderson
- School of Psychology and Psychiatry, Monash University, 900 Dandenong Rd., Caulfield East, Victoria 3145, Australia.
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Abstract
OBJECTIVES We identify recent models for programmes aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. METHODS Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease and rheumatologic disease. RESULTS Programmes with three separate foci were identified: (1) Programmes that guide family members in setting goals for supporting patient self-care behaviours have led to improved implementation of family support roles, but have mixed success improving patient outcomes. (2) Programmes that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviours. (3) Programmes that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. DISCUSSION The next generation of programmes to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programmes, the most effective combinations of support strategies, and how best to integrate family support programmes into comprehensive models of chronic disease care.
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Affiliation(s)
- Ann-Marie Rosland
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA.
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Kaldjian LC, Shinkunas LA, Bern-Klug M, Schultz SK. Dementia, goals of care, and personhood: a study of surrogate decision makers' beliefs and values. Am J Hosp Palliat Care 2010; 27:387-97. [PMID: 20167835 DOI: 10.1177/1049909109358660] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surrogate decision makers for persons with advanced dementia play a key role in making decisions about medical treatments for their loved ones. We conducted in-depth interviews of 20 surrogates to examine their goals of care preferences and beliefs about personhood. All surrogates believed the goal of comfort was important, and 30.0% believed that curing physical problems was important. Significant proportions of surrogates acknowledged dementia-related changes in patients' ability to reason, communicate, and relate to others. Qualitative findings demonstrated diverse beliefs regarding the impact of dementia on factors related to personhood, for example, dignity, respect from others, and having a life worth living. In conclusion, the surrogates we interviewed expressed diverse preferences regarding goals of care and diverse assessments about the impact of dementia on personhood.
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Affiliation(s)
- Lauris C Kaldjian
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Marsland E, Bowman J. An interactive education session and follow-up support as a strategy to improve clinicians' goal-writing skills: a randomized controlled trial. J Eval Clin Pract 2010; 16:3-13. [PMID: 20367810 DOI: 10.1111/j.1365-2753.2008.01104.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent research indicates that allied health clinicians have difficulty articulating client needs and priorities into specific and measurable goals. As a result, a number of strategies to facilitate improvement in allied health clinicians' goal-setting skills have been recommended in the literature. In order to assist clinicians develop the skills required to set SMART goals, it is necessary that the strategies are rigorously tested. AIM To determine if a 50-minute education session and 3-month email and telephone support programme improves clinicians' SMART goal-writing skill and accurately predicts improved goal-writing behaviour. METHODS Concealed random allocation of participants (n = 120) into two parallel groups: (1) intervention group received education on writing goals using the SMART Goal Evaluation Method as part of a workshop on outcome measurement and received 3 months of follow-up support (n = 60); and (2) control group attended a workshop on evidence-based practice (n = 60). RESULTS Education and follow-up support improved clinicians' SMART goal-writing skills at both the 3- and 6-month review (Yates chi(2) = 4.324, d.f. = 1, P = 0.0375). Structural equation modelling revealed education and follow-up support is an accurate predictor of SMART goal-setting behaviour change at both 3 months (standardized regression weights = 0.21; P = 0.014) and 6 months (standardized regression weights = 0.19; P = 0.02) post intervention. Changes were modest and developed over a 6-month period. CONCLUSION This study provides empirical evidence that a programme of educating clinicians in a standardized method of goal setting and providing follow-up support improves allied health clinicians' SMART goal-writing skills.
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Affiliation(s)
- Elisabeth Marsland
- Occupational Therapist, Department of Housing, Sydney, NSW, Australia and Macarthur Home Modifications and Maintenance Service, Sydney, NSW, Australia.
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Gustafsson S, Edberg AK, Johansson B, Dahlin-Ivanoff S. Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review. Eur J Ageing 2009; 6:315. [PMID: 28798613 PMCID: PMC5547347 DOI: 10.1007/s10433-009-0132-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The objective was to investigate definitions of frailty used in studies of multi-component health promotion and disease-preventive (HPDP) intervention programmes for community-dwelling frail elderly persons and to review the content, organisation and effects of HPDP interventions. A systematic review of 19 articles was made, and the International Classification of Functioning, Disability and Health (ICF) was used as a structural framework for the analysis. The result shows that a consensus was reached on including various aspects of impairments in body functions and structures as an integral part of the frailty concept, with the exception of one subgroup: mental/cognitive functions. Additionally, opinions varied quite consistently regarding aspects of activity limitations and participation restrictions, personal and environmental factors. Ten of the 14 HPDP programmes covered various intervention elements referring to all four ICF components. Eleven programmes involved registered personnel only, while a more divergent pattern was seen in the remaining organisational aspects of the interventions: length of interventions and location plus age segments, participatory approach and contextual information, as well as the theoretical foundation of the interventions. Measures of body functions and structures were significantly improved in 5 out of 17 (29%) targeted aspects. For activity and participation, 12 out of 32 (38%) targeted aspects were positively changed, while the score for environmental factors was 7 out of 22 (32%), and for personal factors 8 out of 22 (36%). Our review suggests that further research is needed to explore and disentangle the complex interrelationships between various interventions and outcomes.
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Affiliation(s)
- Susanne Gustafsson
- Institute of Neuroscience and Physiology/Occupational Therapy, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anna-Karin Edberg
- The Vårdal Institute, The Swedish Institute for Health Science, University of Gothenburg, Gothenburg, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Boo Johansson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Synneve Dahlin-Ivanoff
- Institute of Neuroscience and Physiology/Occupational Therapy, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- The Vårdal Institute, The Swedish Institute for Health Science, University of Gothenburg, Gothenburg, Sweden
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Schoeb V. “The goal is to be more flexible” – Detailed analysis of goal setting in physiotherapy using a conversation analytic approach. ACTA ACUST UNITED AC 2009; 14:665-70. [DOI: 10.1016/j.math.2009.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 02/16/2009] [Accepted: 02/24/2009] [Indexed: 11/24/2022]
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Scobbie L, Wyke S, Dixon D. Identifying and applying psychological theory to setting and achieving rehabilitation goals. Clin Rehabil 2009; 23:321-33. [DOI: 10.1177/0269215509102981] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. Objectives: (i) To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify `candidate' theories that that offer most potential to inform clinical practice. Methods: The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Results: Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Conclusions: Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework.
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Affiliation(s)
- Lesley Scobbie
- Alliance for Self Care Research, Department of Nursing and Midwifery, University of Stirling,
| | - Sally Wyke
- Alliance for Self Care Research, Department of Nursing and Midwifery, University of Stirling
| | - Diane Dixon
- Department of Psychology, University of Stirling, Stirling, Scotland
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Kaldjian LC, Curtis AE, Shinkunas LA, Cannon KT. Review Article: Goals of Care Toward the End of Life: A Structured Literature Review. Am J Hosp Palliat Care 2008; 25:501-11. [DOI: 10.1177/1049909108328256] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Goals of care are often mentioned as an important component of end-of-life discussions, but there are diverse assessments regarding the type and number of goals that should be considered. To address this lack of consensus, we searched MEDLINE (1967—2007) for relevant articles and identified the number, phrasing, and type of goals they addressed. An iterative process of categorization resulted in a list of 6 practical, comprehensive goals: (1) be cured, (2) live longer, (3) improve or maintain function/quality of life/ independence, (4) be comfortable, (5) achieve life goals, and (6) provide support for family/caregiver. These goals can be used to articulate goal-oriented frameworks to guide decision making toward the end of life and thereby harmonize patients' treatment choices with their values and medical conditions.
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Affiliation(s)
- Lauris C. Kaldjian
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center,
| | - Ann E. Curtis
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
| | - Laura A. Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine
| | - Katrina T. Cannon
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
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