Sheeba Rosewilliam1, Carron Sintler2, Anand D Pandyan3, John Skelton4, Carolyn A Roskell4. 1. University of Birmingham, Birmingham, UK s.b.rosewilliam@bham.ac.uk. 2. Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK. 3. Keele University, UK. 4. University of Birmingham, Birmingham, UK.
Abstract
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.
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.
Authors: Rebecca Lewthwaite; Carolee J Winstein; Christianne J Lane; Sarah Blanton; Burl R Wagenheim; Monica A Nelsen; Alexander W Dromerick; Steven L Wolf Journal: Neurorehabil Neural Repair Date: 2018-02 Impact factor: 3.919
Authors: Kevin Mertz; Romil F Shah; Sara L Eppler; Jeffrey Yao; Marc Safran; Ariel Palanca; Serena S Hu; Michael Gardner; Derek F Amanatullah; Robin N Kamal Journal: Med Decis Making Date: 2020-08-01 Impact factor: 2.583