Decision-making and goal-setting in chronic disease management: baseline findings of a randomized controlled trial

In Patient Education & Counseling, Shreya Kangovi and colleagues, including Nandita Mitra, Karen Glanz, David Grande, and Judith Long, investigate decision-making in chronic disease management – whether patients are making the ‘right choices’ from a biomedical perspective, whether patients and providers are setting goals of appropriate difficulty, and what types of support the patients will need to accomplish their goals. The authors analyzed goals and action plans from a trial of collaborative goal-setting that used a literacy aid with 302 residents of a high-poverty urban region who had multiple chronic conditions. Motivating this study is that providers tend to communicate with patients of low socio-economic status in a narrowly biomedical, physician dominated manner, characterized by low patient involvement in decision-making. This lack of engagement can lead to mistrust, decisional conflict, and low adherence, particularly in the context of chronic disease management, which requires a sustained patient-provider partnership and an active patient role in health behavior change. The authors find that when given the choice, the patients in their study prioritized chronic conditions that were relatively poorly controlled, and set ambitious individualized chronic disease management goals with their primary care provider. Patients created patient-driven action plans for reaching their goals, which spanned domains including health behavior (58.9%) and psychosocial (23.5%). The authors suggest that these patient-driven action plans could have a tremendous impact and would require health care personnel to support patients using a blend of coaching, social support and navigation.