Putting Patients’ Goals First: Learnings from Primary Care Stakeholders

Context Primary care is in constant transformation to address emerging challenges such as the increasing number of chronic conditions posing questions on how to optimize care delivery. One of the suggested strategies is a focus on patients’ goals to reorient care delivery away from the diseases to the needs and preferences of the persons.

Objective To explore the perspectives of primary care stakeholders towards putting patients’ goals first, the strategies they therefore use, and the challenges they encounter.

Study Design and Analysis Data were analyzed following a qualitative, phenomenological-hermeneutical philosophy of Lindseth and Norberg.

Setting or Dataset Data were collected in six focus groups, organized in four waves with primary care stakeholders. The interview guide handled about topics relating to their understanding and interests in patients’ goals and the adoption and implementation of patients’ goals in their practice.

Population studied Primary care stakeholders (=41) representing academics, policy makers, and primary care providers. The participants were selected using a maximal variation, purposive sampling method.

Intervention/Instrument A semi-structured with open ended questions is used to guide focus group discussions.

Outcome Measures/Results The primary care stakeholders reported that they intrinsically created openness towards their patients by exploring what is important to them and by giving them information about their options to strive for their life goals and best quality of life. They also involved informal caregivers and the social environment of the patient by eliciting their goals and valuing their role during the care process. The participants integrated these goals in interprofessional collaboration. However, to engage patients’ in sharing their goals and being able to put the patients’ goals first, the participants mentioned that they have to acquire skills to elicit them and organizational transformations have to occur prior to sustainable putting patients’ goals first.

Conclusions The participants showed an open attitude to put patients’ goal first. To do so, they integrated insights of the one-on-one conversations they had with their patients, the perspectives of informal caregivers, and the interprofessional team. However, challenges were detected in the area on the personal level of the provider and the organizational level.