The effects of mutual goal setting on the outcomes of care of the patients in the community

Abstract

BACKGROUND: Non-adherence to treatment leads to deterioration of chronic diseases and increased demand of health care system. King's theory of goal attainment asserts that if nurses and patients interact to set mutual goals, patients are more likely to adhere to treatment protocols. Guided by this theory, this study examined if mutual goal-setting (MGS) between community nurses and patients improved the outcomes of care. METHODS: The study employed a quasi-experimental design with repeated measures. Ninety-six patients were recruited from 13 Community Nursing Service centres and allocated into two groups. Mutual goals were set with a Goal Inventory. The outcome measures were goal achievement, perceived functional ability, perceived health status, self-efficacy in managing chronic illness, and health service utilization; they were compared at the baseline (T0), at 4 weeks (T1), at 12 weeks (T2), and at 24 weeks (T3). Patient satisfaction was also evaluated. RESULTS: At the end of the study (T3), 27 (28%) had dropped out, in approximately equal proportions from both groups. Repeated measures, ANOVA were used to assess the treatment effects between groups, the treatment effect of individual groups across time, and the interaction effects between the groups and time. The intervention group achieved significantly higher percentage of their goals than the control group at T1 (85.8% vs. 45.7%, p < 0.001), T2 (96.3% vs. 54.7%, p < 0.001), and at T3 (98.0% vs. 61.5%, p < 0.001).The intervention group achieved significantly greater goal achievement (p < 0.001) and sustained over time. Patients in the intervention group tended to set their care goals in the area of health maintenance. Insignificant group and time interaction effects between groups were found in perceived functional ability, perceived health status, self-efficacy in managing chronic illness. Mann-Whitney U tests revealed no significant differences between groups in health service utilization (i.e. emergency room visits, length of hospital stays, and unplanned readmissions to hospital within 28 days after discharge) at different time points. However, all outcome measures, except for self-efficacy in managing chronic illness, showed significant improvement over time with-group. For patient satisfaction, insignificant difference between groups was reported at T1. DISCUSSION: Patient goals were achieved significantly faster and achievement was sustained over time in the intervention group; the findings are consistent with most studies in terms of goal achievement. New findings are emerged: MGS enables faster and more sustained goal achievement in patients, and mutual goals are health maintenance focused. The insignificant findings in perceived health status and self-efficacy in managing chronic illness were not consistent with other studies; it may be due to inadequate control of the study intervention; the concepts of the intervention may not applicable and sufficient to bring about change in these patients. Despite insignificant differences in many outcomes, MGS encourages mutual presence in nurse-patient interaction and facilitates patients to develop specific goals of care pertinent to their individualized needs and treatment protocol. CONCLUSION: MGS enables faster and sustainable goal achievement in patients and motivate patients to self-manage their chronic conditions effectively.