Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial

Abstract

Objective Growing interest in collaborative goal-setting has raised questions. First, are patients making the ‘right choices’ from a biomedical perspective? Second, are patients and providers setting goals of appropriate difficulty? Finally, what types of support will patients need to accomplish their goals? We analyzed goals and action plans from a trial of collaborative goal-setting among 302 residents of a high-poverty urban region who had multiple chronic conditions. Methods Patients used a low-literacy aid to prioritize one of their chronic conditions and then set a goal for that condition with their primary care provider. Patients created patient-driven action plans for reaching these goals. Results Patients chose to focus on conditions that were in poor control and set ambitious chronic disease management goals. The mean goal weight loss −16.8lbs (SD 19.5), goal HbA1C reduction was −1.3% (SD 1.7%) and goal blood pressure reduction was −9.8 mmHg (SD 19.2 mmHg). Patient-driven action plans spanned domains including health behavior (58.9%) and psychosocial (23.5%). Conclusions High-risk, low-SES patients identified high priority conditions, set ambitious goals and generate individualized action plans for chronic disease management. Practice implications Practices may require flexible personnel who can support patients using a blend of coaching, social support and navigation.

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

“…A recent systematic review of goal setting with patients who were older confirmed the need for studies to examine the effects of personalised care planning on goal attainment, ‘especially patient’s personal goals as opposed to goals determined by clinicians or researchers’ 27. Kangovi et al found that patients with chronic conditions from low socioeconomic groups thought broadly about their goals when encouraged to 28. Most published literature on goal setting suggests goals are often constrained or amended by the healthcare team, frequently clinically prioritised rather than patient prioritised, amended or constrained by the clinician, and reoriented to a biomedical focus,29 – 31 and, in rehabilitation settings, there is evidence that patients may be ill prepared to play a more proactive role and therefore not have goals in mind 32…”

Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study

“…34,44 Given the skills and time required to listen to the patient narrative, calculate an individual risk profile, and communicate risk–benefit implications for each patient, the quality of decision support aids for medications to prevent stroke in patients with atrial fibrillation falls short. 45…”

“…34,44 Given the skills and time required to listen to the patient narrative, calculate an individual risk profile, and communicate risk-benefit implications for each patient, the quality of decision support aids for medications to prevent stroke in patients with atrial fibrillation falls short. 45 Patients' trust in providers' recommendations does not eliminate the need for patient involvement in decisionmaking. While providers were "reluctant to prescribe" OACs due to bleeding risk, patients reported a willingness to accept the bleeding risk and take OACs, if recommended.…”

Why Effective Interventions Do Not Work for All Patients

“…Details of this trial have been previously described. 16–18 Briefly, enrollment took place between July 2013 and October 2014 at two urban internal medicine clinics. Eligible patients lived in a high-poverty region and were diagnosed with two or more of the following chronic diseases: diabetes, obesity, hypertension or tobacco dependence.…”