gms | German Medical Science

Background: Goal setting is an integral component of patient-centered physiotherapeutic care. It serves to motivate patients, align the healthcare team's efforts, prevent oversight of crucial actions, and facilitate the prompt cessation of ineffective interventions. However, the extent to which goal setting is implemented in clinical practice can be expanded.

Objective: To identify existing facilitators and barriers for physiotherapists to document the patient’s treatment goal.

Method: The study was conducted at a university hospital. In the documentation system of this hospital, physiotherapists have the opportunity to record a patient-centered goal for the hospital stay, as defined by the patient. A survey study and two focus group discussions were conducted to identify facilitators and barriers to utilizing this tool. The used survey, informed by a systematic review on facilitators and barriers for shared decision-making and the theoretical domains framework (TDF), included 25 statements on potential influencing factors. To each statement the physiotherapist could agree, partly agree, be neutral, partly disagree, or disagree, further they had the option to indicate that they do not want or can respond to the statement. The focus groups addressed two identified barriers from the survey, discussed the process of setting treatment goals with patients, and brainstormed existing facilitators and barriers for documenting physiotherapeutic goals in the hospital setting. The focus groups were recorded and analyzed by two researchers independently, afterwards, the findings were discussed and combined.

Results: The survey was completed by eight of 80 physiotherapists invited to participate. There was agreement or neutralism on four statements: the goal is set together with the patient, the goal influences the therapeutic interventions, patients and therapists are motivated by the goal, and the goal-setting tool is ok. Further, the therapists disagreed or were neutral regarding two statements: the goal does influence beyond the hospital stay, and the goal is of interest to other professions. Conflicting responses were observed for the remaining statements. At the focus group discussions, three and five physiotherapists participated, respectively. We identified four main themes regarding facilitators and barriers to their goal setting:

1.

The hospital setting e.g. joint goal setting was deemed infeasible for some patients, particularly in the intensive care unit.

2.

The goal-setting tool e.g. concerns were raised about insufficient space and suboptimal placement in the documentation system.

3.

Physiotherapists’ self-conception e.g. the treatment goals are often conceptualized mentally rather than documented.

4.

Interprofessional: e.g. the documentation and goal setting were perceived to lack interest from other professions and were thus not prioritized.

Conclusions: Facilitating the documentation of patient-centered physiotherapeutic goals in hospital settings requires careful design and integration of the tool in collaboration with interprofessional staff, whose engagement can foster documentation practices. Recognition of the influence of professional self-conception on the goal-setting process is essential and warrants intervention. Acknowledging situations where physiotherapists may need to set goals independently from patient input is crucial for comprehensive goal-setting practices.

Funding: Other funding