. 2023 Jul 17;14(5):1011–1019. doi: 10.1007/s41999-023-00830-w

Table 1.

Practical advices for implementing recommendations 1, 2 and 3

Components of the goal setting conversation	Recommendation number, source and considerations
Preparation questions for exploring the patient’s starting position: • Have you previously received rehabilitation? (Are you familiar with the concept of goal setting?) • What did they tell you? • What do you require to recover?	Recommendation: 1,2 and 3 Source: video recordings, experience of research team and publications [7, 22, 24–26, 32, 36] Considerations: ‘Is this patient familiar with the concept of goal setting and emotionally ready for this conversation’ are important questions, entering this conversation. This is done by exploring expectations, knowledge, prior experience with rehabilitation and goal setting, and issues that distract from a goal setting conversation
Explanation of the conversation’s purpose: “This conversation is intended to cover two topics: 1. What do you need to be able to perform, to return home? 2. What else is necessary for you to be able to live at home again and to get your life back on track?”	Recommendation: 1 and 3 (matching the patient’s language & the interplay between participants leads to meaningful goals) Source: experience of research team and literature [11, 12, 15, 28, 36] Considerations: The distinction between functional goals that focus on discharge home and ‘other’ goals (e.g., participation goals, patient’s dreams, goals on cognition or mood) makes the goals more meaningful for the patients, and prevents from therapist-led choice of just ‘privileged goals’. [27]
Explanation of the patient's role (patient is an expert on himself): Briefly name options, e.g., “There are various ways to determine those rehabilitation goals. One way is for you to say what the goals are, another is for the doctors and therapists (that is “we”) to say what the goals are and a third way is for us to talk about it and decide together. Which do you prefer if I put it that way?”	Recommendation: 2 (opening the conversation about the patient’s desire to participate in decision making: how do you do that?) Source: video recordings and publications [22, 32, 36] Considerations: -
Goal setting conversation, either COPM or other type	Recommendation: 1, 2 and 3 Source: Publications [11, 12, 15, 17, 22, 24, 26, 28, 30, 31, 33–36] Considerations: The purpose of this cycle is not to choose the best goal setting intervention. For the Recommendation ‘the interplay between participants leads to meaningful goals’ interesting insights were found that can help the GR professionals improve the interplay between the goal setting participants - Use of a decision aid - For some patients it is helping to break down goals into smaller parts - Professionals prefer goals (‘privileged goals’) characterized by short timeframes, conservative estimation of outcomes, and physical function. The selection of other types of goals is unlikely - Patients goals deemed unattainable by the rehabilitation team are never agreed on - When professionals cannot agree on a patient's goals, they employ strategies such as: 1. Focusing on the admission rather than the long term if the possibility of success is uncertain; 2. Presenting information in a step-by-step manner to elicit agreement; 3. Indicating that the goal is essentially non-negotiable, for example, by writing it down, 4. Collaborating with other team members to formulate goals 5. Making use of the authority implicit in the professional role; 6. Moving on to the next goal despite signs of patient resistance - When patients use words like “Well….” or “I think ….” They might doubt if they are able to articulate goals
Summary and clarification • Summarize the goals and explain what disciplines are involved to reach the goals • Ask back if it is clear • Ask ‘What other questions do you have?’	Recommendation: 1. (matching the patient’s language) Source: video recordings, experience of research team and publications [17, 27] Considerations: The Pharos factsheet [26] emphasized the significance of these points in transferring the plan from the therapist’s head to the patient's. The final point ("What other questions do you have?") proved to be far more inviting than “Do you have any questions?”. Instead of being expected to understand everything, the patient is expected to have questions

Components of the goal setting conversation

Recommendation number, source and considerations

Preparation questions for exploring the patient’s starting position:

• Have you previously received rehabilitation? (Are you familiar with the concept of goal setting?)

• What did they tell you?

• What do you require to recover?

Recommendation: 1,2 and 3

Source: video recordings, experience of research team and publications [7, 22, 24–26, 32, 36]

Considerations: ‘Is this patient familiar with the concept of goal setting and emotionally ready for this conversation’ are important questions, entering this conversation. This is done by exploring expectations, knowledge, prior experience with rehabilitation and goal setting, and issues that distract from a goal setting conversation

Explanation of the conversation’s purpose:

“This conversation is intended to cover two topics:

1. What do you need to be able to perform, to return home?

2. What else is necessary for you to be able to live at home again and to get your life back on track?”

Recommendation: 1 and 3 (matching the patient’s language & the interplay between participants leads to meaningful goals)

Source: experience of research team and literature [11, 12, 15, 28, 36]

Considerations: The distinction between functional goals that focus on discharge home and ‘other’ goals (e.g., participation goals, patient’s dreams, goals on cognition or mood) makes the goals more meaningful for the patients, and prevents from therapist-led choice of just ‘privileged goals’. [27]

Explanation of the patient's role (patient is an expert on himself):

Briefly name options, e.g., “There are various ways to determine those rehabilitation goals. One way is for you to say what the goals are, another is for the doctors and therapists (that is “we”) to say what the goals are and a third way is for us to talk about it and decide together. Which do you prefer if I put it that way?”

Recommendation: 2 (opening the conversation about the patient’s desire to participate in decision making: how do you do that?)

Source: video recordings and publications [22, 32, 36]

Considerations: -

Goal setting conversation, either COPM or other type

Recommendation: 1, 2 and 3

Source: Publications [11, 12, 15, 17, 22, 24, 26, 28, 30, 31, 33–36]

Considerations: The purpose of this cycle is not to choose the best goal setting intervention. For the Recommendation ‘the interplay between participants leads to meaningful goals’ interesting insights were found that can help the GR professionals improve the interplay between the goal setting participants

- Use of a decision aid

- For some patients it is helping to break down goals into smaller parts

- Professionals prefer goals (‘privileged goals’) characterized by short timeframes, conservative estimation of outcomes, and physical function. The selection of other types of goals is unlikely

- Patients goals deemed unattainable by the rehabilitation team are never agreed on

- When professionals cannot agree on a patient's goals, they employ strategies such as: 1. Focusing on the admission rather than the long term if the possibility of success is uncertain; 2. Presenting information in a step-by-step manner to elicit agreement; 3. Indicating that the goal is essentially non-negotiable, for example, by writing it down, 4. Collaborating with other team members to formulate goals 5. Making use of the authority implicit in the professional role; 6. Moving on to the next goal despite signs of patient resistance

- When patients use words like “Well….” or “I think ….” They might doubt if they are able to articulate goals

Summary and clarification

• Summarize the goals and explain what disciplines are involved to reach the goals

• Ask back if it is clear

• Ask ‘What other questions do you have?’

Recommendation: 1. (matching the patient’s language)

Source: video recordings, experience of research team and publications [17, 27]

Considerations: The Pharos factsheet [26] emphasized the significance of these points in transferring the plan from the therapist’s head to the patient's. The final point ("What other questions do you have?") proved to be far more inviting than “Do you have any questions?”. Instead of being expected to understand everything, the patient is expected to have questions