Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium.
Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium.
PLoS One. 2022 Feb 4;17(2):e0262843. doi: 10.1371/journal.pone.0262843. eCollection 2022.
The healthcare system is faced by an ageing population, increase in chronic conditions and multimorbidity. Multimorbid patients are faced with multiple parallel care processes leading to a risk of fragmented care. These problems relate to the disease-oriented paradigm. In this paradigm the treatment goals can be in contrast with what patients value. The concept of goal-oriented care is proposed as an alternative way of providing care as meeting patients' goals could have potential benefits. Though, there is a need to translate this concept into tangible knowledge so providers can better understand and use the concept in clinical practice. The aim of this study is to address this need by means of a concept analysis.
This concept analysis using the method of Walker and Avant is based on a literature search in PubMed, Embase, Cochrane Library, PsychInfo, CINAHL, OTSeeker and Web of Science. The method provides eight iterative steps: select a concept, determine purpose, determine defining attributes, identify model case, identify additional case, identify antecedents and consequences and define empirical referents.
The analysis of 37 articles revealed that goal-oriented care is a dynamic and iterative process of three stages: goal-elicitation, goal-setting, and goal-evaluation. The process is underpinned by the patient's context and values. Provider and patient preparedness are required to provide goal-oriented care. Goal-oriented care has the potential to improve patients' experiences and providers' well-being, to reduce costs, and improve the overall population health. The challenge is to identify empirical referents to evaluate the process of goal-oriented care.
A common understanding of goal-oriented care is presented. Further research should focus on how and what goals are set by the patient, how this knowledge could be translated into a tangible workflow and should support the development of a strategy to evaluate the goal-oriented process of care.
医疗保健系统面临着人口老龄化、慢性病和多种疾病的增加。患有多种疾病的患者面临着多个平行的护理过程，导致护理碎片化的风险。这些问题与以疾病为导向的范式有关。在这种范式中，治疗目标可能与患者的价值观相冲突。目标导向护理的概念被提出作为提供护理的另一种方式，因为满足患者的目标可能有潜在的好处。然而，需要将这个概念转化为具体的知识，以便提供者能够更好地理解和在临床实践中使用这个概念。本研究旨在通过概念分析来满足这一需求。
这项使用 Walker 和 Avant 方法的概念分析基于对 PubMed、Embase、Cochrane 图书馆、PsychInfo、CINAHL、OTSeeker 和 Web of Science 中的文献进行搜索。该方法提供了八个迭代步骤：选择一个概念、确定目的、确定定义属性、确定模型案例、确定附加案例、确定前因和后果以及定义经验参考。
对 37 篇文章的分析表明，目标导向护理是一个动态和迭代的三个阶段过程：目标引出、目标设定和目标评估。该过程以患者的背景和价值观为基础。提供目标导向护理需要提供者和患者的准备。目标导向护理有可能改善患者的体验和提供者的幸福感，降低成本，并改善整体人口健康。挑战在于确定经验参考来评估目标导向护理的过程。
提出了对目标导向护理的共同理解。进一步的研究应集中于患者如何和设定什么样的目标，如何将这方面的知识转化为具体的工作流程，并应支持制定评估目标导向护理过程的策略。
