title: How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care.
abstract: OBJECTIVE
  Patients with complex long-term needs experience multiple parallel care processes, which may have conflicting or competing goals, within their individual patient trajectory (iPT). The alignment of multiple goals is often implicit or non-existent, and has received little attention in the literature.
  
  
  OBJECTIVE
  (1) What goals for care relevant for the iPT can be identified from the literature? (2) What goal typology can be proposed based on goal characteristics? (3) How can professionals negotiate a consistent set of goals for the iPT?
  
  
  METHODS
  Document content analysis of health service research papers, on the topic of 'goals for care'.
  
  
  METHODS
  With the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed.
  
  
  METHODS
  70 papers that describe 'goals for care', 'health' or 'the good healthcare process' relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar.
  
  
  RESULTS
  We developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient's personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines.
  
  
  CONCLUSIONS
  Personal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and wide-sweeping attitudinal, organisational and regulatory transformation of care delivery.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: G K R
authors.initials: GK
authors.lastname: Berntsen
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Gammon
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Steinsbekk
authors.affiliation: Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Salamonsen
authors.affiliation: Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: N
authors.initials: N
authors.lastname: Foss
authors.affiliation: Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Ruland
authors.affiliation: Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: V
authors.initials: V
authors.lastname: Fønnebø
mesh_terms: D015897:Comorbidity; D003695:Delivery of Health Care; D006040:Goals; D006302:Health Services Research; D006801:Humans; D018802:Patient-Centered Care