Background Rehabilitation and goal setting can support one of the key principles of palliative care, to help people live actively until they die. However no theory based practice framework exists. A framework for goal setting in palliative care (G-AP-PC) was developed and implemented systematically in a hospice through 4 phases.
Aims Develop and implement Goal setting and Action planning for Palliative Care [G-AP PC],) to guide and support patient-centred goal setting in practice.
Methods Phase 1: Gathering Information about goal setting practice through a structured literature review and observation of practice in one hospice.
Phase 2: Identifying and applying theories which could underpin a goal setting framework and support patient-centred goal setting.
Phase 3: Use of a participatory approach, based on Normalization Process Theory (NPT) to develop and implement a framework for goal setting.
Phase 4 Evaluation of the impact of implementing GAP-PC, using interviews (patients/ professionals), a questionnaire (professionals) and case note analysis.
Results G-AP PC was successfully implemented. It helped professionals to work as a team; shift their attention from symptoms/problems/risk to patient's goals; act on what patients wanted to achieve, within short timescales and provide written evidence that patients were working towards goals. Patients reported that use of G-AP PC allowed them to focus on goals that were important to them. There was also evidence that goal setting helped increase their motivation and self-efficacy.
Conclusions Use of an explicit, theory based goal setting framework provides a mechanism for ensuring that individual based and patient centred goals are established, documented and reviewed, thus making the goal setting and the work towards achieving and adjusting (as appropriate and necessary) patients goals more focused and explicit. Implementation of this type of framework is not without its challenges, but use of NPT provides a structure to anticipate potential difficulties.
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