Despite communication and cognitive impairment–person-centred goal-setting after stroke: a qualitative study

Abstract

Purpose: The inclusion of rehabilitation clients with communication and/or cognitive impairments after stroke in person-centred goal-setting is challenging. Moreover, this group of clients has largely been excluded from studies, resulting in a lack of knowledge about how to optimize their participation. The aim of this study was to explore strategies that are used in rehabilitation to involve stroke survivors with communication and/or cognitive impairment in person-centred goal-setting. Materials and methods: Eleven stroke rehabilitation professionals participated in semi-structured in-depth interviews. Thematic analysis was undertaken to describe their practice-based strategies. Results: Twenty-one aspects of person-centred goal setting were described from the data and grouped according to five themes: flexibility, trusting relationships, enabling empowerment, techniques for one-to-one interaction, and involving relatives. Participants did not distinguish between approaches for clients with either communication or cognitive impairments but drew from a repertoire of strategies to best meet the individual person’s needs. Participants’ practice combined the conscientious and deliberate application of various strategies with a mind-set that it is possible to involve clients with communication and cognitive impairments in person-centred goal-setting. Conclusions: These findings offer insights into inclusive person-centred goal-setting practices, based on accounts from a group of experienced rehabilitation clinicians.Implications for rehabilitation The goal-setting process is not rigid, but an evolving and individual practice, and should be individually adapted to the (changing) needs of the client during the continuum of rehabilitation. In practice, strategies tend not to be distinguished into those supporting communication and those supporting cognitive difficulty; but strategies are applied flexibly and in combination, to meet the needs of the individual client. It is important to provide specific and sufficient support as well as enough time to enable participation for clients with communication and/or cognitive impairment in goal-setting. Leaving one’s own values, preferences, attitudes and notions of “normality” behind can help rehabilitation practitioners to get to know the client, be sensitive towards all signs the client offers during a conversation, and remain open to differing and alternative viewpoints when considering goals.