The influence of patient-centredness during goal-setting in stroke rehabilitation

I bet this patient centered goal setting is still influenced by the staff, biasing what survivors expectations should be.  The goal should be 100% recovery but I bet implicit and explicit interference from hospital staff relegates the goals to maybe walking, eating and dressing.
http://etheses.bham.ac.uk/7033/

Abstract

Background: Guidelines suggest that rehabilitation for people with stroke should adopt patient-centred goal-setting (PCGS).
Methods: A literature review and two qualitative studies were done in an acute stroke-unit. Study one aimed to explore influence of PCGS within stroke rehabilitation. Patients with stroke, with ability to participate and staff caring for them were included. Data collection involved interviews, observations, document analysis and focus-groups. Analysis involved sequential and intra-case analysis methods.
Study two aimed to build a resource to improve PCGS and evaluate its feasibility and appropriateness. Based on Study one and review, a resource (T-PEGS) was developed and applied in this setting. Patients with same criteria as Study one and staff who agreed to act as keyworkers were recruited. Data collection and analysis methods were similar to Study one.
Findings: Study one, with thirteen patients and twelve professionals, revealed limited application of PCGS due to participants’ health beliefs, limitations in knowledge and resources. Study two involved five patients and five staff who applied T-PEGS; recording of psychosocial goals, information sharing and rapport between patients and professionals had improved.
Conclusion: T-PEGS seemed to improve PCGS locally. Small study-size and single site limit generalisability. Future work should explore mechanisms and effectiveness of T-PEGS.