Article

OBJECTIVE: To explore whether goal-setting for rehabilitation with acute stroke
survivors is patient-centred and identify factors which influence the adoption of
patient-centredness in goal-setting practice.
SETTING: Acute stroke unit in a
large teaching hospital in England. PARTICIPANTS: Patients with stroke who had no
cognitive or significant communication problems and health care professionals who
had a significant engagement with an individual patient were approached for
participation. METHOD: Multiple qualitative methods were used. Perceptions and
beliefs about patient-centredness, within the context of goal-setting, were
collected from patients and corresponding professionals using qualitative
semi-structured interviews. Adoption of patient-centred behaviour was
triangulated using analysis of patient records and observation of team meetings
related to participating patients. DATA ANALYSIS: Interview transcripts and field
notes were coded, clustered under categories and descriptively summarised.
Additionally, data from patients' documents were summarised. These summaries were
then mapped on to an a-priori frame work of patient-centredness from which
further interpretative themes were derived. RESULTS: Seven patients and seven
health-care professionals participated. Goal-setting was not consistently
patient-centred as evidenced by a) incongruities between patients and
professionals in setting, communicating and prioritising of goals and b)
dysfunctional therapeutic relationships. The factors that influenced
patient-centred goal-setting were both professional and patient beliefs and
attributes, work-culture, practice model, limitations in knowledge and systems
that disempowered both professionals and patients. CONCLUSION: It may be possible
to infer that current local practice of goal-setting was inadequately
patient-centred. Further research is required to identify strategies to overcome
these challenges and to develop patient-centred goal-setting methods.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS