Collaborative goal-setting: stakeholders’ experiences, barriers and facilitators.

Background: Goal-setting is an approach that encourages the use of self-defined goals of care in the process of decision-making. It is already a commonly known concept in rehabilitation and end-of life care. Several positive effects have been listed in previous research. At University Medical Center Utrecht it appears that only few doctors document goals of care in patient records. This study aims to identify stakeholders’ experiences with goal-setting and the barriers and facilitators to discussing, documenting and using goals of care in individual health care. Methods: A qualitative study design was used. In-depth topic-interviews were held with 19 healthcare professionals (HCPs) and 7 patients. Results: Although the majority of HCPs and patients share a positive attitude towards goal-setting, it appears hard to accomplish. This study identified that that most HCPs are not consistent in discussing values, preferences and goals with their patients. Many different barriers to goalsetting are identified, including the ambiguity concerning the interpretation of goals, organisational barriers, patient-related barriers and the uncertainty about the usefulness and feasibility of goal-setting in every setting or situation. Most stakeholders agree that the current methods of goal-setting are not adequate. Conclusion: Based on our findings, the formulation of purely medical goals might be useful to improve communication between HCPs and provide clarity to patients. However, purely medical goals attribute less to performing care that is person-centered. Further research is recommended to identify ways to overcome the barriers and to develop a strategy for meaningful goal-setting in different care settings.