Choosing treatment goals that match your daily life

Start with the activity behind the symptom

A lot of people start talking to me. I want to get rid of the pain. That's an understandable wish. Then ask what would change in your day if the symptom was less disturbed. Do you want to cook again, ride to work, lift a child or resume a hobby?

That follow-up question makes the goal more concrete. The same painful region can have a very different meaning for different people. For one sleep is the greatest constraint, for the other is a task that is necessary to remain independent. There is no ranking in which sport is more important or less important than an ordinary daily act.

Write down three activities you're missing in advance. Then choose which one should be discussed first. A short priority list helps to direct the consultation and prevents only the easiest measurable symptom from getting attention.

Make a distinction between wish, purpose and appointment

A wish describes the outcome you hope for. A goal makes clear what functions you want to change. An appointment describes what you and the clinician are doing to investigate or support that. Those three don't have to be the same sentence.

The example does not prescribe distance or term. Those details depend on your starting point and the assessment. An objective becomes stronger when the circumstances are clear, not when it sounds as ambitious as possible.

The NICE guideline on co-decision asks to take into account what is important for someone and to discuss options, consequences and uncertainty. Therefore, your goal is part of the choice of care, not just with a questionnaire afterwards.

Choose a measuring bar that matches the question

A pain rate may be useful, but it doesn't tell you everything about an activity. Maybe you can cook longer with the same pain, or you need less help while a score doesn't change much. The other way around, the pain can be lower because you don't do anything anymore. Therefore, the context of an outcome is important.

Think of what you want to follow for each purpose: execution, duration, assistance, interruptions or participation. Choose only what has meaning to you. A trader may also use a standardised questionnaire or measurement. Ask how that information is interpreted along with your experience.

In sport, the Bern consensus on sport resumption see why participation, resumption and performance are different phases. Reconnecting with a training can thus be a different goal than directly achieving the previous level. It helps to identify these differences in advance.

Discuss the price of a goal

A treatment plan takes time, energy and sometimes money. It may also conflict with other priorities. An extensive training program is less feasible if your work and care tasks already require a lot of questions. Discuss those circumstances before a plan is drawn up.

Ask in a proposed treatment what contribution one expects to make to your chosen goal. What outcome has been investigated, how certain is this knowledge and what are the disadvantages or practical burdens? Also ask which alternatives exist, including a different approach or no additional treatment for the time being. NICE explicitly includes those choice options in decision making together.

Sometimes you consciously choose a more modest first goal because it suits your life better. That's not a lack of motivation. It's a decision on feasibility. Make visible what you win with it and what wish you save for later.

Prepare an evaluation interview

Use a simple target sheet with four fields: my activity, my starting point, our appointment and what I want to discuss in evaluation. Put in a date that you're looking back at. The date is an appointment to learn, not a promise that the goal must be achieved.

Please note what has actually been done in the evaluation. If a work appointment didn't go through or exercises were unclear, that should be considered. Otherwise, you will judge a plan that has hardly happened in practice.

Then compare the relevant activity under identifiable circumstances. Also tell unexpected gain or loss: better sleep, more confidence or less space for other things. Thus, the plan can be adapted to the whole of your daily functioning and not just to one pre-selected number.

A target may change

New information can make another priority logical. Perhaps a sports goal is still far away, while a daily task now takes precedence. Or the diagnosis changes, which requires a different treatment first. Adapting a goal is then part of good consultation.

Ask at the end of the conversation if you can summarize the appointment in your own words. It shows whether you and the clinician mean the same thing. For example: we're going to try this, we're going to follow this and I'll contact you in this change. NICE advises understandable information and control as to whether it is properly understood.

A useful purpose gives you hold without capturing the future. You know which activity is central, which step has been chosen and when the plan is reviewed. This also makes it easier to discuss when treatment does not contribute enough and another choice is needed.