Date Presented 03/26/20
Although there are beneficial effects of person-centered goal-setting interventions for adults with chronic health conditions and disabilities, it has not been fully implemented in clinical practice. This study provides insights into current person-centered goal-setting interventions and future directions. A future person-centered goal-setting intervention should incorporate diverse intervention components that address all goal-setting phases and encourage clients’ engagement in goal-setting phases.
Primary Author and Speaker: Eunyoung Kang
Additional Authors and Speakers: Moon Young Kim, Erin Foster
PURPOSE: Person-centered goal-setting benefits health and healthcare-related outcomes for adults with chronic health conditions and disabilities (Rosewilliam, Roskell, & Pandyan, 2011). Despite agreement about the importance of person-centered goal-setting, it has not been fully implemented in clinical practice (Holliday, Antoun, & Playford, 2005). Goal-setting should consist of five different phases; preparation, formulation of goals, formulation of action plans, coping planning, and follow-up (Stevens, Beurskens, Köke, & van der Weijden, 2013). This study aims to investigate what components of person-centered goal-setting and to what extent have been used.
DESIGN: We conducted a systematic review of person-centered goal-setting interventions for adults with chronic health conditions or disabilities.
METHOD: We searched PubMed/MEDLINE, EMBASE, CINAHL, SCOPUS, and Web of Science for relevant articles published through October 2019. We used the following eligibility criteria: 1) empirical study, 2) explicit mention of the use of behavioral change theory to guide intervention development, 3) intervention focused on patients, and 4) aim to improve health or healthcare-related outcomes. We extracted data from the eligible studies on 1) study participants’ demographic and clinical characteristics, 2) the theoretical framework that guided intervention development, 3) what components of person-centered goal-setting were used and to what extent, and 4) study outcomes.
RESULTS: We identified 6 studies that met the inclusion criteria. Included studies were conducted in persons with rheumatic diseases (n=1), ischemic stroke (n=1), type 2 diabetes (n =3), and chronic obstructive pulmonary disease or chronic heart failure (n =1). Motivational interviewing (n =3) and self-efficacy theory (n =2) were most commonly used to guide the development of person-centered goal-setting. None of the included studies included all components of the goal-setting process. The preparation and follow-up phases had a strong presence; whereas the goal formulation, action planning, and coping planning phases had a weaker presence. The most commonly used intervention components (n =5) were goal plan formulation, action plan formulation, and support for the patients to attain goals. Other common intervention components (n =4) were patient education, patient reflection, identification of topics for setting goals, identification of barriers to carrying out the action plan, and evaluation of progress or achievement. Coping planning phase-related intervention components (i.e., identification of facilitators (n =3), assessment of confidence about carrying out the action plan (n =3), and coping plan formulation (n =1)) were particularly poorly addressed. The included interventions, which used person-centered goal-setting, benefitted health-related knowledge, healthy behaviors, psychological well-being, and quality of life compared to standard-of-care.
CONCLUSION: These results provide insight into current person-centered goal-setting intervention practices. Person-centered goal-setting interventions should incorporate all goal-setting phases and encourage clients’ engagement in all goal-setting phases. Future studies to determine the optimal combinations of intervention components at each goal-setting phase for successful person-centered goal setting implementation are required.
References
Rosewilliam, S., Roskell, C. A., & Pandyan, A. (2011). A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clinical rehabilitation, 25(6), 501-514. https://doi.org/10.1177/0269215510394467
Holliday, R. C., Antoun, M., & Playford, E. D. (2005). A survey of goal-setting methods used in rehabilitation. Neurorehabilitation and neural repair, 19(3), 227-231. https://doi.org/10.1177/1545968305279206
Stevens, A., Beurskens, A., Köke, A., & van der Weijden, T. (2013). The use of patient-specific measurement instruments in the process of goal-setting: a systematic review of available instruments and their feasibility. Clinical rehabilitation, 27(11), 1005-1019. https://doi.org/10.1177/1545968305279206
