Goal-Setting in clinical practice: a study of health-care professionals’ perspectives in outpatient multidisciplinary rehabilitation of patients with spinal cord injury

Abstract

Purpose

Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals’ perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury.

Materials and methods

An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality.

Results

Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach.

Conclusions

We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients’ perspectives in the practice is needed.

Implications for rehabilitation

• To strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting.

• Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI.

• SMART goals are not always the right way to formulate rehabilitation goals.

• A flexible and pragmatic approach is needed to reach a balance between the patients’ complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.

Keywords:

• Goal-setting
• health-care professionals’ perspectives
• spinal cord injury
• multidisciplinary
• rehabilitation
• qualitative study

Acknowledgements

The authors thank health-care professionals and patients from the hospital for their willingness to participate in this study and for openly sharing their considerations and experiences.

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This work was supported by a grant from the Offerfonden (The Council of the Danish Victims Fund; grant number: 18-910-00073).