Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists' views on goal-setting with people with chronic obstructive pulmonary disease

Clin Rehabil. 2017 Jul;31(7):978-991. doi: 10.1177/0269215516658937. Epub 2016 Jul 20.

Abstract

Objective: To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings.

Participants: A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location.

Method: Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim.

Data analysis: Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used.

Results: Three themes emerged through the process of analysis: (1) 'Explaining goal-setting'; (2) 'Working with goals'; and (3) 'Influences on collaborative goal-setting'. Goal-setting practices among respiratory physiotherapists varied considerably. Collaborative goal-setting was described as challenging and was sometimes driven by service need rather than patient values. Lack of training in collaborative goal-setting at both undergraduate and postgraduate level was also seen as an issue.

Conclusion: Respiratory physiotherapists reflected uncertainties around the use of goal-setting in their practice, and conflict between patients' goals and organisational demands. This work highlights a need for wider discussion to clarify the purpose and implementation of goal-setting in respiratory rehabilitation.

Keywords: Chronic obstructive pulmonary disease (COPD); goal -setting; pulmonary rehabilitation; qualitative study.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Patient Care Planning*
  • Physical Therapists / standards*
  • Physical Therapists / trends
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Qualitative Research
  • Respiratory Therapy / standards*
  • Respiratory Therapy / trends
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • United Kingdom