Open AccessA three‐goal model for patients with multimorbidity: A qualitative approach
Author(s) -
Vermunt Neeltje P.,
Harmsen Mirjam,
Elwyn Glyn,
Westert Gert P.,
Burgers Jako S.,
Olde Rikkert Marcel G.,
Faber Marjan J.
Publication year - 2018
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/hex.12647
Subject(s) - thematic analysis , hierarchy , qualitative research , goal setting , psychology , goal orientation , clinical practice , computer science , management science , medicine , knowledge management , applied psychology , nursing , social psychology , sociology , market economy , social science , economics
Background To meet the challenge of multimorbidity in decision making, a switch from a disease‐oriented to a goal‐oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. Objective This study aimed to develop conceptual descriptions of goal‐oriented care by examining the perspectives of general practitioners ( GP s) and clinical geriatricians ( CG s), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. Method Qualitative interviews with GP s and CG s were conducted and analyzed using thematic analysis. Results Clinicians distinguished disease‐ or symptom‐specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. “Fundamental goals” are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. Conclusion Based on the perspectives of clinicians, we expanded the concept of goal‐oriented care by identifying a three‐level goal hierarchy. This model could facilitate collaborative goal‐setting for patients with multiple long‐term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice.