Review Dialogues as an Opportunity to Develop a Person-related Overall Diagnosis

Abstract

Background: Family physicians accompany people of all ages whose health situation is closely connected to missions and tasks in their family context. These tasks are modified throughout their life span and form the background for their individual health goals which are, however, rarely discussed in encounters with General Practitioners (GP). A specific instrument, the Review Dialogue (RD), has been developed to help in obtaining a person-related overall diagnosis and in agreeing on health goals shared by both patient and GP. Research question: Do regularly conducted RDs help in identifying specific development challenges, in agreeing on and achieving corresponding health goals? Methods: In a cluster-randomised controlled intervention study using mixed methods, we examined the ways in which RDs contribute to the achievement of shared health goals. In the qualitative part of the study, video-recorded encounters and the processes of negotiating health goals were analysed. This paper illustrates in a case study the relationship between the patients’ development tasks and health goals. Our presentation is based on the in-depth analysis of 20 case histories (mostly 2-4 video-recorded RDs). We illustrate our methods by means of an exemplary case study in which way the specific development tasks have been focused on in the RDs and correspond to the shared health goals. Results: RDs assist in creating awareness of the meaning of the patient’s biographically-based current tasks. Thus, theyvimprove the capacity to reflect on the interrelationship of these tasks and the health goals. Discussion: Disease-related goals and biographically developed health-related life goals need to be determined. The processvof developing goals is an integral part of the health process itself. Clarifying roles and responsibilities is essential.