A View into Current Goal Setting Practice – Results from an Observational Study
Pain is a common and disabling feature of many disease states. It is frequently not well controlled by existing therapies. In this talk I will review the scope of the problem and some recent developments aimed at improving our understanding of the underlying mechanisms and treatment. In particular I will review our understanding of what molecular entities drive pain in damaged tissues and how these resulting signals are processed – and in many cases amplified – in the central nervous system. An important question is why people with apparently similar levels or disease or injury can experience very different amounts of pain. I will review how genetic and epigenetic processes might contribute to relative pain vulnerability or resilience.
Point of departure of the presented study was observed differences among rehabilitation institutions with regard to patient outcome that cannot be accounted for by known variables. The aim of the Meer-project was to identify characteristics of rehabilitation institutions that could contribute to understanding differences between institutions with regard to patient outcome.
A comprehensive qualitative study embedded into a mixed-methods project was conducted. The project included a qualitative study in which we made 1-week-visitations of two members from our research team in six rehabilitation facilities, four from the domain of musculoskeletal rehabilitation, two from cardiac rehabilitation, three with positive patient outcome above and below average, respectively. We conducted focus groups with professionals, focus groups with patients, individual interviews with directors (medical and administration), as well as a number of participant observations (from perspectives of the patient and professionals).
One of the main categories that emerged depicting substantive difference between institutions was related to goal setting. In all of the six rehabilitation facilities goals were more or less set by the physicians in charge of the patient. However, in rehabilitation facilities with rather successful outcomes there were indications for participation of patients within this process. Within facilities of rather low outcome goal setting physicians seemed to have been merely motivated by obligatory documentation requirements or by enhancing so-called patient compliance. In the patient-therapist encounter in rehabilitation facilities with rather successful outcomes therapists and patients apply rather participatory approaches to mutual goal setting. It could be observed from the patients' accounts that in facilities of rather low outcome patients do not describe the goal setting activities as meaningful to them, while in rehabilitation facilities with rather successful outcomes we have found statements that represent feelings of being valued and respected.
On the basis of our results we can substantiate the hypothesis that participatory goal setting is related to positive patient outcome, although the underlying mechanism still remains elusive. In the light of further results of the MeeR project there seems to be a relationship of participatory goal setting to good interdisciplinary team work and a general stance of the rehabilitation facility of patient-orientation and respect towards the different rehabilitation professionals.