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BMC Health Services Research

, 13:190

Organization, structure and delivery of healthcare

Abstract

BackgroundGoal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework G-AP to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning and coping planning and appraisal and feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.

MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.

ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: i health professionals were concerned about the impact of goal non-attainment on patient’s well-being patients did not share their concerns, and ii some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.

ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

KeywordsStroke rehabilitation Goal setting Process evaluation Multi-disciplinary team AbbreviationsSMARTSpecific, measurable, achievable, realistic-relevant and timed

G-APGoal setting and action planning

MRCMedical research council

NHSNational health service.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-190 contains supplementary material, which is available to authorized users.

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Autor: Lesley Scobbie - Donald McLean - Diane Dixon - Edward Duncan - Sally Wyke

Fuente: https://link.springer.com/







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