title: Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study.
abstract: OBJECTIVE
  To explore whether goal-setting for rehabilitation with acute stroke survivors is patient-centred and identify factors which influence the adoption of patient-centredness in goal-setting practice.
  
  
  METHODS
  Acute stroke unit in a large teaching hospital in England.
  
  
  METHODS
  Patients with stroke who had no cognitive or significant communication problems and health care professionals who had a significant engagement with an individual patient were approached for participation.
  
  
  METHODS
  Multiple qualitative methods were used. Perceptions and beliefs about patient-centredness, within the context of goal-setting, were collected from patients and corresponding professionals using qualitative semi-structured interviews. Adoption of patient-centred behaviour was triangulated using analysis of patient records and observation of team meetings related to participating patients.
  
  
  METHODS
  Interview transcripts and field notes were coded, clustered under categories and descriptively summarised. Additionally, data from patients' documents were summarised. These summaries were then mapped on to an a-priori frame work of patient-centredness from which further interpretative themes were derived.
  
  
  RESULTS
  Seven patients and seven health-care professionals participated. Goal-setting was not consistently patient-centred as evidenced by a) incongruities between patients and professionals in setting, communicating and prioritising of goals and b) dysfunctional therapeutic relationships. The factors that influenced patient-centred goal-setting were both professional and patient beliefs and attributes, work-culture, practice model, limitations in knowledge and systems that disempowered both professionals and patients.
  
  
  CONCLUSIONS
  It may be possible to infer that current local practice of goal-setting was inadequately patient-centred. Further research is required to identify strategies to overcome these challenges and to develop patient-centred goal-setting methods.
authors.affiliation: University of Birmingham, Birmingham, UK s.b.rosewilliam@bham.ac.uk.
authors.forename: Sheeba
authors.initials: S
authors.lastname: Rosewilliam
authors.affiliation: Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK.
authors.forename: Carron
authors.initials: C
authors.lastname: Sintler
authors.affiliation: Keele University, UK.
authors.forename: Anand D
authors.initials: AD
authors.lastname: Pandyan
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Skelton
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Roskell
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D006040:Goals; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010358:Patient Participation; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D020521:Stroke / Q000150:complications / Q000523:psychology*; D000071939:Stroke Rehabilitation / Q000379:methods / Q000523:psychology / Q000592:standards*
keywords: Stroke; goal-setting; multi-disciplinary; patient-centredness