Brauner Laurien, Neijenhuis Karin, Dalemans Ruth, Wees Philip J van der, Gerrits Ellen
Research Centre Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
Department of Languages, Literature and Communication, Institute for Language Sciences (ILS), Utrecht University, Utrecht, the Netherlands.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13138. doi: 10.1111/1460-6984.13138.
Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations.
A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question: What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services?
METHODS & PROCEDURES: The qualitative study was carried out in the setting of routine speech-language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews. Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client-SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs.
OUTCOMES & RESULTS: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes.
CONCLUSIONS & IMPLICATIONS: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.
What is already known on the subject SLTs want to set meaningful goals together with their patients but lack theory and resources to effectively shape the goal-setting process. Few studies have directly reported on the perspectives and needs of SLTs and patients regarding goal setting. Patients generally perceive goal setting as a vague activity in which they minimally participate. SLTs want to involve patients in the goal-setting process and describe the potential benefits, but they also want to report barriers on the systemic and professional competence level. What this paper adds to the existing knowledge SLTs and patients perceive shared goal setting as a multifaceted process, rather than a one-off conversation. This process holds potential vulnerabilities for SLTs and patients alike, and the themes in this study propose potentially helpful ingredients to mediate this vulnerability and shape the goal-setting process. What are the potential or clinical implications of this work? To take the first steps towards effective shared goal setting, SLTs should embrace the element of discovery in goal setting and apply their expert knowledge in supporting communication. To develop practical interventions for SLTs, shared goal setting needs to be further conceptualized and embedded in policy and clinical guidelines.
目标设定是言语和语言治疗师（SLT）临床推理过程中的一个重要步骤，这些治疗师为患有沟通障碍的儿童、青少年和成人提供护理。根据以患者为中心的护理理念，（国际）指南建议在SLT和患者之间进行共同或协作的目标设定。由于理论框架和实际干预措施稀缺且不太适用于广泛的沟通障碍人群，SLT在实施（共同）目标设定方面面临挑战。
开发理论和实际干预措施的第一步是探索SLT和患者关于日常目标设定实践的第一手经验。本研究受以下研究问题的指导：在常规SLT服务中，SLT和沟通障碍患者对于（共同）目标设定的观点和需求是什么？
这项定性研究在荷兰的社区实践、小学教育和神经康复的常规言语治疗服务环境中进行。数据收集遵循视频反思民族志的原则，使用目标设定对话的视频片段来促进半结构化的反思性访谈。数据分析基于反思性主题分析。总共对12对患者 - SLT进行了访谈，涵盖了有一系列沟通困难的儿童、家长和成人及其SLT的观点。
数据分析产生了四个主题，其中两个包含子主题。每个主题代表在SLT和患者访谈中发现的一个核心组织概念。这些主题被确定为：（1）目标设定是一个复杂的过程；（2）目标讨论需要在沟通上易于理解；（3）沟通参与目标难以把握；（4）关系的重要性。在这些主题下探讨了权力不平衡、沟通障碍、有效的沟通策略以及动机和信任等主题。
鼓励SLT将共同目标设定视为一个需要明确规划并与患者沟通的过程，无论患者年龄或沟通障碍如何。在支持沟通方面，SLT拥有专业知识和技能，在目标讨论中应用这些技能可能会加强共同目标设定并促进治疗关系。有必要具体地将共同目标设定概念化并纳入政策和临床指南中。在SLT和沟通障碍患者持续参与的情况下，所报告的主题对制定此类政策以及SLT实践中的共同目标设定干预措施具有初步的临床意义。
关于该主题已知的信息 SLT希望与患者共同设定有意义的目标，但缺乏有效塑造目标设定过程的理论和资源。很少有研究直接报告SLT和患者关于目标设定的观点和需求。患者通常将目标设定视为一项模糊的活动，他们参与度极低。SLT希望让患者参与目标设定过程并描述潜在益处，但他们也希望报告系统和专业能力层面的障碍。本文对现有知识的补充 SLT和患者将共同目标设定视为一个多方面的过程，而不是一次性的对话。这个过程对SLT和患者都存在潜在的风险，本研究中的主题提出了可能有助于调节这种风险并塑造目标设定过程的有益因素。这项工作的潜在或临床意义是什么？为了朝着有效的共同目标设定迈出第一步，SLT应在目标设定中接受探索元素，并应用其专业知识来支持沟通。为了为SLT开发实际干预措施，共同目标设定需要进一步概念化并纳入政策和临床指南中。
