title: Elucidating a Goal-Setting Continuum in Brain Injury Rehabilitation.
abstract: For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., "the goal is discharge") and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice.
authors.affiliation: Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Hunt
authors.affiliation: Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Guylaine
authors.initials: G
authors.lastname: Le Dorze
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Trentham
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Helene J
authors.initials: HJ
authors.lastname: Polatajko
authors.affiliation: University of Toronto, Toronto, Ontario, Canada Baycrest Hospital, Toronto, Ontario, Canada ddawson@research.baycrest.org.
authors.forename: Deirdre R
authors.initials: DR
authors.lastname: Dawson
mesh_terms: D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D009788:Occupational Therapy / Q000379:methods*; D010347:Patient Care Planning; D010465:Perception; D011209:Power, Psychological; D011582:Psychological Theory; D036301:Qualitative Research
keywords: Canada; brain injury; goal setting; grounded theory; health care, culture of; qualitative; rehabilitation