Mind the gap: Patients’ experiences and perceptions of goal setting in palliative care

Background: Palliative care aims to support people to live as actively as possible until death. A rehabilitative approach which includes goal setting could be an important way of achieving this. Goal setting is well established in best practice guidelines for palliative care. However little is known about how the process of goal setting actually happens in practice, especially from patients’ points of view. We aimed to investigate patients’ expectations, experience and perceptions of goal setting in one hospice.Methods: We conducted 15 semi-structured interviews with a sample of patients who had been admitted to a Scottish hospice for symptom control. Interviews were digitally recorded, transcribed verbatim and analysed using Framework Analysis.Results: Participants understood and valued goal setting but did not always share their goals with hospice staff. These were often participants’ own personal activity-based goals that they worked on in parallel, but not always in partnership with hospice professionals. Participants were able to adapt their goals as their situation changed.Conclusions: Our findings revealed a gap between the goals that participants identified and worked towards compared with those that participants perceived the professionals focussed on. As a result, opportunities were missed for patients and professionals to work together to achieve goals.This work was funded by Strathcarron Hospice and the University of Stirling.https://doi.org/10.1080/09699260.2019.167213127pubpub

Patient centred goal setting in a hospice setting: A comparative case study of how healthcare practitioners understand and use goal setting in practice

Aim: To investigate healthcare practitioners' understanding and practice of patient centred goal setting in a hospice. Methods: A comparative case study of 10 healthcare practitioners in one hospice. Nonparticipant observations (n=28), semi-structured interviews (n=10) and case-note analysis (n=67) were undertaken. Data were analysed using framework analysis. Results: Participants viewed goal setting as part of routine practice. However, goal setting focused around what was seen as important from the health practitioner's perspective rather than being person centred. Participants' goal setting practice was implicit and opportunities to support patients to pursue goals were missed. Participants emphasised problem solving and alleviating symptoms rather than focusing on patient priorities and establishing patient centred goals. Conclusion: While goal setting is valued, it is practiced in an implicit, practitioner centred and inconsistent manner. An explicit person centred goal setting process may support practitioners consistently help patients to identify their priorities and enhance their quality of life.sch_nur24pub5355pub