Goal-setting in clinical medicine

The process of setting goals for medical care in the context of chronic dis ease has received little attention in the medical literature, despite the i mportance of goal-setting in the achievement of desired outcomes. Using qua litative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from emb edded values but are distinct from values. Goals vary based on specific cir cumstances and alternatives whereas values are person-specific and relative ly stable in the face of changing circumstances. Second, goals are hierarch ical in nature, with complex mappings between general and specific goals. T hird, there are a number of factors that modify the goal-setting process, b y affecting the generation of goals from values or the translation of gener al goals to specific goals. Modifying factors related to individuals includ e their degree of risk-taking, perceived self-efficacy, and acceptance of t he disease. Disease factors that modify the goal-setting process include th e urgency and irreversibility of the medical condition. Pertinent character istics of the patient-family-clinician interaction include the level of par ticipation, control, and trust among patients, family members, and clinicia ns. The research suggests that the goal-setting process in clinical medicin e is complex, and the potential for disagreements regarding goals substanti al. The nature of the goal-setting process suggests that explicit discussio n of goals for care may be necessary to promote effective patient-family-cl inician communication and adequate care planning. (C) 1999 Elsevier Science Ltd. All rights reserved.