Practical Patient-Centered Goal Setting

Motivational interviewing is an effective strategy for encouraging health behavior change and improving outcomes for people with alcoholism, substance abuse, and several chronic medical conditions.^1,2 Despite its effectiveness, translating the use of motivational interviewing into primary care visits has proven difficult because of the increased time it takes to get at the “whys” behind patients' behaviors.

Two key elements for successful health behavior change are that the patient must have 1) the desire to change and 2) the confidence that they can change. Only then can you help the patient establish a workable process for change.

Using a modification of motivational interviewing principles to promote health behavior change has significantly increased my effectiveness at helping my patients set goals they want to accomplish and they succeed in completing. This process is about helping patients build the skill of setting a goal they can — and want to — accomplish and keep. Many health conditions are amenable to motivational goal setting, but this article will focus on four areas where this can be done in a reasonable amount of time in the office setting. Those areas are 1) nutrition, 2) activity, 3) emotional well-being, and 4) smoking reduction.

When setting goals with patients, be careful not to set too many goals at once and to tailor the goals to what is most important for them regarding health behavior change. For example, if a patient has diabetes and wants to lose weight and control their blood sugar, setting one nutrition goal and one activity goal is reasonable.

The four steps to setting patient-centered goals are described below and labeled IQSC:

• Identify what the patient wants to change,
• Quantify what they are doing now,
• Get the patient to set a goal they guarantee they are going to keep, no matter how small the goal may be,
• Confirm the goal is theirs, not yours. Many patients will say they are going to do something in order to please their doctor, not because they intend to do it; therefore, make sure the goal is focused on what they want to do, not what they think you want them to do.