Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study
Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study
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DOI：
10.1177/0269215515584167
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发表时间：
2016-05-01
影响因子：
3
通讯作者：
Roskell, Carolyn A.
中科院分区：
文献类型：
--
作者：
Rosewilliam, Sheeba;Sintler, Carron;Roskell, Carolyn A.
目的：探讨急性脑卒中幸存者康复目标的设定是否以患者为中心，并确定影响在目标设定实践中采用以患者为中心的因素。没有认知或重大沟通问题的卒中患者和与患者有重大接触的医疗保健专业人员进行了接触，方法：采用多种定性研究方法。关于以病人为中心的看法和信念，在目标设定的背景下，收集病人和相应的专业人员使用定性半结构化访谈。采用以病人为中心的行为进行三角分析，使用患者的记录和观察的团队会议参与patients.Data analysis：采访成绩单和现场笔记进行编码，分类下聚类和简要总结。此外，还总结了患者文件中的数据。这些摘要，然后映射到一个先验的框架工作的患者为中心，进一步解释themes.Results：七名患者和七名医疗保健专业人员参加。目标设定并非始终以患者为中心，表现为：a）患者与专业人员在目标设定、沟通和优先级排序方面存在不协调，以及B）治疗关系失调。影响以患者为中心的目标设定的因素是专业和患者的信念和属性，工作文化，实践模式，知识和系统的限制，剥夺专业人士和patient.Conclusion：它可能是可以推断的，目前当地的目标设定的做法是不充分的以患者为中心。需要进一步研究，以确定克服这些挑战的战略，并制定以患者为中心的目标设定方法。
Objective: To explore whether goal-setting for rehabilitation with acute stroke survivors is patient-centred and identify factors which influence the adoption of patient-centredness in goal-setting practice.Setting: Acute stroke unit in a large teaching hospital in England.Participants: Patients with stroke who had no cognitive or significant communication problems and health care professionals who had a significant engagement with an individual patient were approached for participation.Method: Multiple qualitative methods were used. Perceptions and beliefs about patient-centredness, within the context of goal-setting, were collected from patients and corresponding professionals using qualitative semi-structured interviews. Adoption of patient-centred behaviour was triangulated using analysis of patient records and observation of team meetings related to participating patients.Data analysis: Interview transcripts and field notes were coded, clustered under categories and descriptively summarised. Additionally, data from patients' documents were summarised. These summaries were then mapped on to an a-priori frame work of patient-centredness from which further interpretative themes were derived.Results: Seven patients and seven health-care professionals participated. Goal-setting was not consistently patient-centred as evidenced by a) incongruities between patients and professionals in setting, communicating and prioritising of goals and b) dysfunctional therapeutic relationships. The factors that influenced patient-centred goal-setting were both professional and patient beliefs and attributes, work-culture, practice model, limitations in knowledge and systems that disempowered both professionals and patients.Conclusion: It may be possible to infer that current local practice of goal-setting was inadequately patient-centred. Further research is required to identify strategies to overcome these challenges and to develop patient-centred goal-setting methods.