Goal-oriented care: what makes the patient happy?
What gets you out of bed in the morning? What motivates you? These are questions that doctors don’t often ask their patients. Organising care more on the basis of a patient’s life-goals makes it more efficient. That is the principle of goal-oriented care.
The Doctor Daniël De Coninck Fund invests in primary healthcare which is affordable, caring and of high quality. Goal-oriented care is a recent concept which is gaining significance in primary care. “Because it is a win-win for all those involved,” says Susanne Op de Beeck from the Flemish Patients’ Platform, which promotes the interests of people with chronic diseases.
Last year Susanne Op de Beeck gave a workshop at the Summer Academy run by the De Coninck Fund on goal-oriented care and how to use the concept in practice. “Goal-oriented care not only considers the patient’s symptoms, but also looks at what is important for his or her quality of life.”
Autonomy and self-respect
During this conversation about life-goals the doctor and the patient both gain more wide-ranging insights into the person, but the conversation also generates opportunities to discuss treatments or medication. “It may be small things that used to energise the patient and are no longer possible now, such as going for a walk or having a cup of coffee. Adjusting their medications, providing support or offering practical help can reinforce the patient’s autonomy and his feeling of self-respect.”
During the workshop a GP gave the example of a woman with symptoms of severe pain after an accident, who was also not able to walk properly any more. Before the accident she used to enjoy singing in a choir. After making an adjustment to her pain medication on the days when she has a choir practice and finding a volunteer who can take her along, she can now continue with an activity that energises her and gives her a purpose.
Basing a patient’s care on their life-goals means that they are also better informed about the possible options, such as choices of treatment, and the relevant advantages and disadvantages. This means that making a decision is less intimidating. “The patient gains more insight into his condition and the treatment process, which has a positive impact on his confidence in both the treatment and the doctor. Since his own goals are the starting point, the patient is more motivated and this has a positive effect on compliance with treatment.”
Mind shift for both the care provider and the patient
To help patients think about what is important in their lives and communicate with their care providers, the Flemish Patient Platform has developed Goal Seeker. Goal Seeker is a kind of outline of a person’s life, which can be used in many different ways: the patient can fill it in alone or with help from a partner or another family carer; he can work on it together with the person providing care, or a carer can look at how he or she presents Goal Seeker. He can ask the patient to fill it in once or pick out targeted questions for an interview. “It is an open-ended tool, which patients also find reassuring if they are not very talkative or get nervous when they are talking to a doctor. It allows them to prepare for the consultation. It gives them something to hold on to.”
The concept of goal-oriented care is slowly but surely gaining in popularity, but Op de Beeck notes that many care providers are still thinking through the details of how to work in a goal-oriented way. “They agree with the dynamic and they are thinking about what is possible. A number of them are already moving in the right direction. However, many of them still don’t know how to approach it in practice.”
“One pitfall is that care providers tend still to start from the idea that they know best and that they can sense and guess the patient’s wishes. This means that they don’t listen to what patients view as important. Goal-oriented care therefore requires a mind shift. This will be significant both in basic training and also in continuing training. It will take time.”
Patients experience this mind shift too. Not everyone is used to answering questions of this kind. Patients may not be willing to answer them directly. Goal Seeker helps them to reflect on what they need and provides a structure for those insights. This facilitates and broadens their communication with the care provider. Time is often limited in consultations. Using Goal Seeker, both the patient and the care provider can get straight to the heart of the matter.”
Care providers are looking for good examples that they can use as a model. Op de Beeck sees Care-Esperanto from Familiehulp (Family Aid) West Flanders as a good example of a useful addition to Goal Seeker. Bart Deltour, Care Director at Familiehulp West Flanders presented this methodology at the Summer Academy. They have developed a care template that allows them to arrive at shared commitments on how to support the patient, based on their life-goals. “The main point is that it brings people together. The principle is that care providers are being invited to go on a journey with the person who needs care.”
“Goal-oriented care means working in a very different way. It is quite different from asking patients about the side-effects of medications during a consultation, or checking their blood pressure,” concludes Op de Beeck. “It requires a different kind of conversation, where you need to take time, and it gives you different ways of thinking about treatment. The best results are obtained if every care provider – the GP, physiotherapist, occupational therapist and home care worker – is involved and contributes their own expertise and perspective.”