Most patients with chronic illness must make significant behavior and life changes to achieve good outcomes and live positive lives. Making change is hard to do and difficult to maintain. To succeed, people need two kinds of motivation: positive expectation or hope (the belief that the change will do some good) and confidence or “self-efficacy” (the belief that they can make  the change successfully, even with some slip-ups.) This is why providers can empower patients and families most by supporting their choosing and carrying out their own goals and action plans.

What Kinds of Goals?

 You might think that living a longer life and avoiding complications would be motivator enough, but this only appears to be true for half or fewer of all patients. In one representative study of smokers who had lung surgery to remove tumors, half resumed smoking within a year. Read about it here. Threats of complications and death are motivators for some, but most patients need positive motivators as well.

You can help patients set goals by asking questions like “Is there something you would like to do that your condition prevents you from doing?” “What do you want most in your life now?” “What would make your life better or easier?”  See Setting Positive Goals.

Action Plans are Steps to a Goal

An action plan is a contract a patient makes with him or herself, to accomplish a single objective on the way to achieving that larger goal. If a patient’s goal is to walk three miles a day, they might need to start with an action plan of walking around the block three times a week. The important thing about an action plan is that they succeed at it, building their self-efficacy. See more about action plans in the piece on “Action Planning” in the Patients and Families area of this website.

As with goals, it is best when patients develop their own action plans. However, they may need some guidance from providers when it comes keeping their plans achievable and realistic. When patients devise and begin to achieve action plans and goals that are meaningful to them, they usually gain a growing sense of self-efficacy and become empowered. This increased sense of mastery can have a powerful impact on their lives and health.

Three different action planning forms can be accessed from the box to the right.

Guidelines for Working as a Team to Help Patients Set Goals and Action Plans

Guiding goal setting and action planning can be a lot of work at the beginning, but patients normally pick up these things quickly.

1. The provider role is to introduce the subject, collaborate at the beginning, and then fade as rapidly as possible.
2. Many practices find that interested, well trained support staff can do most of this work effectively and efficiently.
3. One of providers’ most important contributions is to let patients know that they (providers) consider goal-setting and action planning to be very important. Many patients’ previous providers may not have taken self-care quite this seriously.
4. Follow-up reinforces this message. If providers follow-up on goal-setting and action planning, patients take it more seriously. Finding the opportunity to ask “What’s happening with that action plan you set during your last visit?” Or “How do you feel things are going with that exercise goal we talked about four months ago?” or “What action plan are you working on now?”  improves the odds that patients will stay on track with  the improvement efforts they have set for themselves.
5. Charting patients’ goals and action plans is another way to reinforce their importance. It also makes it easier for all members of the care team to be aware of patient plans. See a form for charting self-management.

Who can Do This?

It’s very helpful if providers introduce goal-setting to patients and sign off on their plans. Patients will take it more seriously if clinicians are involved. Most providers lack time to go through the goal-setting process with patients, but anyone on staff can help patients get started. Many practices use medical assistants to do this work. MAs can normally do this after one or two days of training. Other staff or other patients can also work on goal-setting with patients. After being introduced to the practice and trying it a few times, patients usually find they can make their own plans.