Digging Deeper into Patient Goals

Selena Horner — Mon, 27 Aug 2018 10:00:00 +0000

Are we wearing blinders when our typical goal focus for our patients is in the realm of physical function?

As I read through this qualitative study, I had to pause and self-reflect. Okay, I know that “rheumatoid arthritis” seems to be a narrow condition and might not truly be easily extrapolated to all patients. Yet… as I read the article, I could think of the majority of my patients currently being treated by me (with none of them having rheumatoid arthritis).

I have a feeling many patients will have goals within all 4 realms: bodily experience, wanting to be normal, attaining social connectedness and healthcare interactions. Obviously, individuals who have persistent symptoms or a condition without a cure may feel more like the patients within the review. Physical function is a definite goal… yet so many other goals were listed as being important to these individuals. I think that this article helps better explain those situations where a patient I am treating is not a candidate for services or requires a referral to another health care professional. In those situations, after quite a bit of discussion with the patient, I end the conversation apologizing because I won’t be able to help at that time. I am always taken aback by their graciousness and gratitude and their perspective that I helped meet their goal: being where they need to be for the right care and being pointed in the right direction.

The healthcare interactions section feels like a pot of gold. That whole section describes ways to strengthen and grow therapeutic alliance.

You’ll find the abstract to the recent study below.

Patient goals in rheumatoid arthritis care: A systematic review and qualitative synthesis.

Hulen E¹, Ervin A¹, Schue A¹, Evans-Young G², Saha S^1,³, Yelin EH², Barton JL^1,³.

Abstract

OBJECTIVE:

During the clinical encounter, rheumatoid arthritis (RA) patient goals for care often go unexplored. The aim of the present systematic review was to identify needs, goals and expectations of RA patients in order better to guide systematic elicitation of patient goals in clinical encounters.

METHODS:

An academic librarian searched MEDLINE, PsychINFO and the Cochrane Library using a specialized algorithm developed to identify articles about patient goals for RA care. Investigators screened search results according to prespecified inclusion criteria and then reviewed included articles and synthesized the evidence qualitatively, utilizing an inductive approach.

RESULTS:

A total of 909 titles were retrieved in the literature search, of which 871 were excluded after a title/abstract screen. Of the remaining 38, 22 papers were included in the final review. Investigators identified four major themes in the literature: (a) the bodily experience of RA; (b) achieving normalcy and maintaining wellness; (c) social connectedness and support; and (d) interpersonal and healthcare system interactions.

CONCLUSION:

Patients’ goals when receiving care for RA are multidimensional and span several facets of everyday life. Goals for RA care should be collaboratively developed between patients and providers, with particular attention to the patient’s life context and priorities.

Musculoskeletal Care. 2017 Dec;15(4):295-303. doi: 10.1002/msc.1173. Epub 2016 Dec 14.

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