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Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit
  1. Rosaline Holliday (rosaline{at}
  1. Institute of Neurology, United Kingdom
    1. Stefan Cano (s.cano{at}
    1. Institute of Neurology, United Kingdom
      1. Jennifer A Freeman (j.freeman-1{at}
      1. Faculty of Health and Social Work, Plymouth University, Devon PL4 8AA
        1. E Diane Playford (d.playford{at}
        1. Institute of Neurology


          Objectives: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting.

          Design: The study was an AB optimised balance, block design with each block lasting 3 months, over an 18-month period. Setting and Participants Patients (N=201) were recruited from an inpatient neurological rehabilitation unit. Interventions Patients (N=100) recruited in phase A, were involved in ‘usual practice’ goal setting. Patients (N=101) recruited in phase B, were involved in 'increased participation' goal setting, which included a protocol to help them define and prioritise their own goals. Main outcome measures Patients’ perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability.

          Results: Phase B patients ('increased participation') set fewer goals, of which significantly more were participation-related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between groups.

          Conclusion: This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient-centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.

          • clinical decision making
          • goal setting
          • patient centred care
          • patient participation

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