Berntsen G K R, Gammon D, Steinsbekk A, Salamonsen A, Foss N, Ruland C, Fønnebø V
Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
BMJ Open. 2015 Dec 10;5(12):e009403. doi: 10.1136/bmjopen-2015-009403.
Patients with complex long-term needs experience multiple parallel care processes, which may have conflicting or competing goals, within their individual patient trajectory (iPT). The alignment of multiple goals is often implicit or non-existent, and has received little attention in the literature.
(1) What goals for care relevant for the iPT can be identified from the literature? (2) What goal typology can be proposed based on goal characteristics? (3) How can professionals negotiate a consistent set of goals for the iPT?
Document content analysis of health service research papers, on the topic of 'goals for care'.
With the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed.
70 papers that describe 'goals for care', 'health' or 'the good healthcare process' relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar.
We developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient's personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines.
Personal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and wide-sweeping attitudinal, organisational and regulatory transformation of care delivery.
有复杂长期需求的患者在其个人患者轨迹（iPT）中经历多个并行的护理过程，这些过程可能有相互冲突或竞争的目标。多个目标的一致性通常是隐含的或不存在的，并且在文献中很少受到关注。
（1）从文献中可以确定哪些与iPT相关的护理目标？（2）基于目标特征可以提出什么样的目标类型学？（3）专业人员如何协商出一套一致的iPT目标？
对关于“护理目标”主题的卫生服务研究论文进行文献内容分析。
随着多重疾病的患病率不断上升，迫切需要有关跨组织和学科识别和协调护理目标的指导。
通过对MEDLINE、科学网和谷歌学术进行逐步结构化检索，确定了70篇描述与一般iPT相关的“护理目标”“健康”或“良好医疗过程”的论文。
我们开发了一种有四类的目标类型学。三类是专业定义的：（1）功能目标，（2）生物/疾病目标和（3）适应目标。第四类是患者个人定义的目标。专业目标和个人目标可能会冲突，在这种情况下，通过创建目标层次结构来确定目标优先级可能会有所帮助。我们认为患者在这种目标层次结构的顶端具有确定目标的道德和法律权利。然后，专业人员可以将个人目标转化为现实的专业目标，例如与循证指南相关的标准化健康结果。因此，当目标相互一致时，iPT将真正以患者为中心，同时护理遵循专业指南。
个人目标指导专业目标并定义iPT的成功标准。然而，要使个人目标发挥作用，需要在护理提供方面进行大胆而全面的态度、组织和监管变革。
