Pritchard Lesley, Phelan Shanon, McKillop Ashley, Andersen John
Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, Canada.
Disabil Rehabil. 2022 Apr;44(7):1042-1049. doi: 10.1080/09638288.2020.1788178. Epub 2020 Jul 10.
To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting.
Nine children receiving inpatient and outpatient rehabilitation aged 5.0-12.3 years ( = 8.3, SD = 2.3; 5 females) and their parents ( = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children ( = 7), their parents ( = 9), occupational therapists ( = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting.
Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process.
Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.IMPLICATIONS FOR REHABILITATIONChildren are often not optimally involved in setting their own rehabilitation goals.In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.
探讨采用以儿童为主导的方法进行康复目标设定时儿童、家长及临床医生的体验。
9名年龄在5.0 - 12.3岁（平均年龄 = 8.3岁，标准差 = 2.3岁；5名女性）接受住院和门诊康复治疗的儿童及其家长（n = 9）参与了一个旨在使儿童与物理治疗师或职业治疗师的互动最大化的目标设定过程。对7名儿童、9名家长、2名职业治疗师、1名执业护士和1名医生进行了定性访谈，以探讨他们对以儿童为主导的目标设定方法的体验。
确定了反映儿童、家长及临床医生对以儿童为主导的目标设定方法体验的三个主题：（1）儿童有发言权和洞察力；（2）儿童确定的目标对儿童具有激励作用且有益；（3）我们是一个团队：目标设定是一个共同构建的过程。
参与目标设定促成了对功能性目标的确定，这些目标被认为对儿童具有激励作用。儿童表示感觉自己受到重视且意见被听取。家长和临床医生认识到他们此前低估了儿童确定自身目标的能力。关系自主性强调决策的社会和关系层面，在概念化临床医生在协作目标设定中的角色时，可能比传统的个人主义自主性观点更有用。
对康复的启示
儿童在设定自身康复目标时往往未得到最佳参与。
在这项定性研究中，我们报告称，儿童、家长及临床医生认识到优化儿童参与目标设定的价值，包括让儿童感觉自己的意见被听取、受到重视且更有动力参与治疗。
家长表示需要一种尊重儿童、家长及临床医生意见的协作性目标设定方法。
关系自主性可能是重新界定临床医生在协作目标设定过程中角色的有用框架。
