title: Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit.
abstract: OBJECTIVE
  The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting.
  
  
  METHODS
  The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period.
  
  
  METHODS
  Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit.
  
  
  METHODS
  Patients (n = 100) recruited in phase A were involved in "usual practice" goal setting. Patients (n = 101) recruited in phase B were involved in "increased participation" goal setting, which included a protocol to help them define and prioritise their own goals.
  
  
  METHODS
  Patients' perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability.
  
  
  RESULTS
  Phase B patients ("increased participation") set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups.
  
  
  CONCLUSIONS
  This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.
authors.affiliation: Institute of Neurology, University College London, London, UK.
authors.forename: Rosaline C
authors.initials: RC
authors.lastname: Holliday
authors.forename: Stefan
authors.initials: S
authors.lastname: Cano
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Freeman
authors.forename: E Diane
authors.initials: ED
authors.lastname: Playford
mesh_terms: D002985:Clinical Protocols; D006040:Goals; D006801:Humans; D009422:Nervous System Diseases / Q000534:rehabilitation*; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D026684:Personal Autonomy; D016896:Treatment Outcome