Patient-Centered Goal Setting in Developmental Therapy: Discordance between Documented Goals and Caregiver-Perceived Goals

Abstract

Introduction: Productive interactions between engaged patients and clinical teams are key to effective clinical practice. Accordingly, the identification of needs and priorities through the process of collaborative goal setting is fundamental to patient-centered care. Executing a goal-setting process that is truly collaborative is challenging; many caregivers do not feel that they are adequately involved in the goal-setting process. This study presents the results of an initiative intended to understand goal concordance between therapists and caregivers.

Methods: We conducted an observational, cross-sectional design study. Twenty-nine pediatric physical and occupational therapists developed and documented collaborative goals for their patients. Over 6 months, 120 randomly selected caregivers from a weekly list of patients scheduled for a follow-up physical or occupational therapy visit participated. Caregivers completed structured interviews related to their children's therapy goals. We calculated agreement coefficients between caregiver-perceived goals and therapist-documented goals.

Results: Overall strength of agreement was poor (M = -0.03, SD = 0.71). There were no significant differences within variables of a goal setter, goal importance, or goal utility. Median agreement coefficients were greatest for goals perceived to be identified solely by the caregiver, perceived as important, and perceived as functionally useful.

Conclusions: The results of this study underscore the state of discordance in the collaborative goal-setting process in pediatric physical and occupational therapy. Healthcare encounters continue to be framed by provider perspectives and priorities. Developing therapy goals that enhance family involvement, relate to function, and are important to the healthcare consumer may improve the agreement.

Fig. 1.

Boxplots of Gwet’s agreement coefficient (AC₁) as a function of a goal setter. Median AC₁ was greatest for caregivers who perceived that they established the goals, followed by the therapist and caregiver together, and the therapist alone, respectively. The absence of tails in the “Not sure” and “Someone else in my family did it” conditions is reflective of only one caregiver giving this response in each condition.

Fig. 2.

Boxplots of Gwet’s agreement coefficient (AC₁) as a function of goal importance. Median AC₁ was greatest for caregivers who perceived the documented goals as important, followed by caregivers who perceived some of the goals as important. Only one caregiver perceived that the documented goals were not important.

Fig. 3.

Boxplots of Gwet’s agreement coefficient (AC₁) as a function of goal utility. Median AC₁ was greatest for caregivers who reported the functional utility of the documented goals, followed by caregivers who were not sure about the functional utility, and those who did not perceive the goals as functionally useful.

Fig. 4.

Key driver diagram for improved goal concordance between therapists and caregivers. Key drivers reflect caregiver and therapist factors. The study team developed the proposed interventions. COPM, Canadian Occupational Performance Measure; GAS, Goal Attainment Scaling; ICF, International Classification of Function, Disability and Health.