Because we are all so used to problem-oriented health care, many people assume that goals are developed after health problems have been identified (e.g. the goals relating to my diabetes are...). Actually, with goal-directed care the goals are established first. Any health problems that may arise are viewed as potential obstacles to achieving those goals or as challenges to be overcome in order to achieve them.
Some people, particularly health care professionals assume that the only goals we are talking about are functional goals (meaningful life activities; quality of life). Actually improving quality of life is only one of four major health goals. For most people the most important goal is (or probably should be) prevention of premature death and disability. If you are dead, quality of life doesn’t matter. The two other major health goals are: achieving optimal growth and development; and experiencing a good death. (There may be some other goals that become important in certain situations for come people.)
Another common misconception is that health goals are (or should be) established entirely by patients. Because they have relevant knowledge and perspective and will be involved in helping people achieve their goals, health care professionals should generally be involved in establishing health-related goals and objectives. Goal setting requires consideration of the values, preferences, resources, and limitations of the patient (individual’s contribution) but also a knowledge of what’s possible medically and what makes sense from the perspective of a knowledgeable unbiased observer (professional’s contribution).
Health care professionals often assume that they can simply ask patients what their goals are. In our clinical experience, that isn’t usually very helpful. Instead we have found that the most useful questions include: What’s a typical day like for you? (Walk me through a typical day in your life.) What would you like to be able to do that you can’t do now What are the things that make life worth living (without which you would rather be dead)? Can you think of specific conditions under which you would not want to be treated for pneumonia (just let you die)? Have you completed an advance directive document? Do you have a durable power of attorney for health care? Have you discussed them with family members?
A goal is a desired outcome for which it makes little or no sense to ask why you would want that to happen. “I’d like to avoid dying from something preventable” is a goal. “I’d like to avoid a heart attack” is an objective, not a goal. “I’d like to reduce my average blood pressure” is a strategy. “I’d like to keep my average systolic blood pressure below 140” is a target. “To accomplish that, I will take this medication” is an action.