title: First experiences with a two-step method for discussing goals with community-dwelling frail older people.
abstract: BACKGROUND
  Although frail older people can be more reluctant to become involved in clinical decision making, they do want professionals to take their concerns and wishes into account. Discussing goals can help professionals to achieve this.
  
  
  OBJECTIVE
  To describe the development of a two-step method for discussing goals with frail older people in primary care and professionals' first experiences with it.
  
  
  METHODS
  The method consisted of (i) an open-ended question: If there is one thing we can do for you to improve your situation, what would you like? if necessary, followed by (ii) a bubble diagram with goal subject categories. We reviewed the goals elaborated with the method and surveyed professionals' (primary care nurses and social workers) experiences, using questions concerning time investment, reasons for not formulating goals, and perceived value of the method.
  
  
  RESULTS
  One hundred and thirty-seven community-dwelling frail older people described 173 goals. These most frequently concerned mobility (n = 43; 24.9%), well-being (n = 52; 30.1%) and social context (n = 57; 32.9%). Professionals (n = 18) were generally positive about the method, as it improved their knowledge about what the frail older person valued. Not all frail older people formulated goals; reasons for this included being perfectly comfortable, not being used to discussing goals or cognitive problems limiting their ability to formulate goals.
  
  
  CONCLUSIONS
  This two-step method for discussing goals can assist professionals in gaining insight into what a frail older person values. This can guide professionals and frail older people in choosing the most appropriate treatment option, thus increasing frail older people's involvement in decision making.
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Sarah H M
authors.initials: SH
authors.lastname: Robben
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Maud M
authors.initials: MM
authors.lastname: Heinen
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Perry
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: René J F
authors.initials: RJ
authors.lastname: Melis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D016330:Frail Elderly; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010347:Patient Care Planning; D059017:Primary Care Nursing / Q000379:methods; D066269:Social Theory
keywords: frailty; goals; patient involvement; primary care