Goals should be defined as CLEVER before specifying them into SMART goals: A phenomenological hermeneutical study to facilitate the implementation of goal-oriented care in primary care

BACKGROUND: Goal-oriented care is prominent in primary care settings due to the rising number of people living with (multiple) chronic conditions. Before goal-oriented care can be fully implemented, a better understanding about the concept of goals needs to be gained. This study aimed to elicit in-depth knowledge through the narratives of people with (multiple) chronic conditions regarding their view on goal setting.

METHOD: In a qualitative research design within a phenomenological-hermeneutical paradigm, 15 in-depth interviews were performed with people living with (multiple) chronic conditions (mean age 65; 38-81) based on a homogeneous sampling strategy.

RESULTS: This study revealed that goal setting starts from talking about everyday activities embedded in a real-life context. A well-defined goal should consist of the context, the life narrative of the patient, the engagement towards a particular goal, the reason why this goal is important in terms of underlying values, the emotions going along the activity, and the relevance for the patient. This leads to CLEVER goals.

CONCLUSION: These findings prompt a reconsideration of traditional goal setting in healthcare, which typically adheres to SMART. Based on the participants' experiences, goals should be defined as CLEVER first before they can be transposed into SMART goals.