Boeckxstaens Pauline, Willems Sara, Lanssens Mieke, Decuypere Charlotte, Brusselle Guy, Kühlein Thomas, De Maeseneer Jan, De Sutter An
Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium.
Department of Internal Medicine, Ghent University, Ghent, Belgium.
J Comorb. 2016 Nov 14;6(2):120-126. doi: 10.15256/joc.2016.6.64. eCollection 2016.
Patients with multiple chronic diseases are usually treated according to disease-specific guidelines, with outcome measurements focusing mostly on biomedical indicators (e.g. blood sugar levels or lung function). However, for multimorbidity, a goal-oriented approach focusing on the goals defined by the individual patient, may be more suitable. Despite the clear theoretical and conceptual advantages of including patient-defined goals in clinical decision-making for multimorbidity, it is not clear how patients define their goals and which aspects play a role in the process of defining them.
To explore goal-setting in patients with multimorbidity.
Qualitative analysis of interviews with 19 patients diagnosed with chronic obstructive pulmonary disease and comorbidities.
Patients do not naturally present their goals. Their goals are difficult to elicit, even when different interviewing techniques are used. Four underlying hypotheses which may explain this finding were identified from the interviews: (1) patients cannot identify with the concept of goal-setting; (2) goal-setting is reduced due to acceptation; (3) actual stressors predominate over personal goal-setting; and (4) patients may consider personal goals as selfish.
Our findings advocate for specific attention to provider skills and strategies that help patients identify their personal goals. The hypotheses on why patients may struggle with defining goals may be useful to prompt patients in this process and support the development of a clinical method for goal-oriented care.
患有多种慢性病的患者通常按照特定疾病指南进行治疗，结果测量主要侧重于生物医学指标（如血糖水平或肺功能）。然而，对于共病情况，一种以个体患者定义的目标为重点的目标导向方法可能更合适。尽管在共病的临床决策中纳入患者定义的目标具有明显的理论和概念优势，但尚不清楚患者如何定义他们的目标以及哪些方面在目标定义过程中发挥作用。
探讨共病患者的目标设定情况。
对19名被诊断患有慢性阻塞性肺疾病及合并症的患者进行访谈的定性分析。
患者不会自然而然地提出他们的目标。即使使用不同的访谈技巧，他们的目标也很难引出。从访谈中确定了四个可能解释这一发现的潜在假设：（1）患者无法认同目标设定的概念；（2）由于接受现状，目标设定减少；（3）实际压力源比个人目标设定更占主导地位；（4）患者可能认为个人目标是自私的。
我们的研究结果主张特别关注有助于患者识别其个人目标的医护人员技能和策略。关于患者在定义目标时可能遇到困难的假设，可能有助于在此过程中引导患者，并支持开发一种以目标为导向的临床护理方法。
