GOAL SETTING DURING PERIODIC HEALTH EXAMS: WHAT TYPES OF GOALS ARE SET AND WHAT IMPACT DOES IT HAVE ON THE VISIT?

Purpose: The US Preventive Services Task Force, among others, has endorsed goal setting as a central component of health promotion. We describe patient-physician goal setting discussions during period health examinations (PHEs) as well as compare the mean length of visits with and without an explicit goal setting discussion.  

Method: Observational study of 485 PHEs to 64 primary care physicians practicing in a large, southeast Michigan Health System between 2007-2009.  Previously collected data from office visit audio recordings and direct observation were combined with pre-visit patient surveys and administrative records for patient and physician characteristics, respectively.  Office visit transcripts were queried in Microsoft Word to identify any use of the word “goal.”  Among visits containing the word “goal,” the first author used a structured worksheet to code goal-related discussions for context (health vs. other) as well as specific patient-centered and collaborative communication techniques, including those developed by Street et al. (2001) and Heisler et al (2003).  

Result:

Among the 485 visits, 98 goal discussions were identified, 59 of which were health-related.  These health-related goals occurred in 49 (10%) visits to 30 different physicians.  Visits with Caucasian patients were more likely to contain a health-related goal discussion (51%/n=30 followed by African Americans 37%/n=22) as were visits to female physicians (71%/n=42 vs. 29%/n=17, p=0.03), but no differences in the likelihood of health-related goal discussion was detected by patient gender, age, body mass index or health status, nor physician age, race or specialty.  The most commonly occurring health-related goals were those related to weight loss (30%), blood pressure (14%), and physical activity (10%).  Over half of goals (56%) were physician set, with the remainder evenly split between patient- and collaboratively-set.  Most (72%) included a discussion of goal-attainment strategies, but relatively few (<37%) contained discussion of the benefits of goal-attainment, patients’ beliefs, or physician partnership building.  When a health-related goal was discussed, the mean time with the physician significantly increased (30.2 vs. 26.6 minutes, p=0.01). 

Conclusion: Despite patients and physicians advocating the utility of PHEs for goal setting, we found only a minority of visits included an explicitly labeled goal.  Furthermore, barely a quarter of those reflected collaboratively set goals. How to foster effective, collaborative goal setting during busy primary care office visits remains an important topic for study.