Goal setting will help patients to gain confidence and control over the process of change. This is a crucial part of self-care that involves choosing health needs assessment priorities, such as becoming fitter, engaging in social activities via social prescribing or managing anxiety.
Your role is to use a coaching style of communication to help your patient identify things they want to change.
Your patient can break down big goals into manageable paced SMART goals. These goals are often called targets.
As primary care professionals you will be familiar with SMART goal setting as part of your continuing professional development. SMART means:
We are not proposing that you will coach your patient forever. Rather, you are teaching them the skill of goal setting and offering positive feedback – then you hand over to them!
Follow the action points below to help you support your patient with goal setting:
Action to take
It is essential that it's the patient rather you who generates the goals – this is much more likely to be effective!
Ideally a goal should be an action (behaviour change) rather than a result, for example “stop snacking between meals” rather than “be thinner.”
Here's an example of how the conversation can start:
Firming it up is all about making a goal SMART. Making this walking goal SMART, it could look like this:
Specific – walking activity Measureable – two kilometres distance Achievable – with three times a week regular smaller distance walks Realistic – paced weekly walk distances increasing each week Time-framed – two kilometres walk distance at the end of 8 weeks
Weekly targets to work towards this SMART goal could look like this:
Remind your patient about pacing the goal
Pacing skills are as important as goal setting skills and they go hand in hand. They make the goal achievable and realistic.
Enable the patient to understand the idea of effort levels. Then they can selecting an effort level between 4-7 out of 10 point scale, usually about right for the activity.
Try using an effort scale like the one below, to help your patient visualise how to gauge the right level of effort.
Over time, when the activity gets too easy or too low effort, it is time to move onto the next SMART goal.
Help your patient to create an action plan
A whole series of goals can be put together to make an action plan – a road map to the big goal.
Plan for setbacks
Explain that setbacks are to be expected. Encourage the patient to identify barriers to success and create a plan to respond to this. Identify what might make lead to success such as using pacing skills.
Encourage your patient to give themselves meaningful rewards
These can be small or large but should be personal to your patient. Multisensory rewards are most helpful for retraining the brain to appreciate other pleasurable sensations apart from pain, for example watching a favourite movie whilst drinking a fruit smoothie or having a hot shower with a new perfumed shower gel whilst listening to my favourite tune.
Resources for your patient
Goal setting leaflet for patients
Next time you are talking to your patient about setting goals, give them this goal setting leaflet to take home with them, and ask for feedback when you next review them.
Extra resources for you
How to eat a plane(!)
Phil Sizer is a specialist in self management for chronic pain and the author of Chronic Pain, the drug free way, published by Sheldon Press. In this article, taken from Live Well with Pain's clinician newsletter, Phil takes a sideways look at goal setting and finds that motivation is everything – as long as you keep chomping!
Summary of key points
- SMART goal setting will help the patient to gain control and confidence over the process of change
- An action plan will help the patient to make and review progress
- The action plan should include rewards to provide positive reinforcement and it should include a setback plan