Standardized Implementation of a Personalized Endpoint: Inventory-Facilitated Goal Attainment Scaling

OBJECTIVES: Goal attainment scaling (GAS) is a clinician-facilitated patient-centric clinical outcome assessment that quantifies the impact of an intervention on personalized goals. Although it has many strengths, such as being highly responsive, inherently clinically meaningful, and non-arbitrary, a lack of standardization in its implementation may challenge its reliability and validity. Here, we utilized a goal inventory to standardize GAS implementation and assessed the acceptability of this approach from the patient/caregiver’s perspective.

METHODS: Twenty-six patient/caregiver dyads (65+ years) participated in goal-setting interviews with four clinicians trained in GAS. Dyads were given a GAS orientation handout (with or without a goal inventory) and asked to set at least one goal. The goal inventory included 37 goals covering multiple domains. GAS acceptability was assessed using multiple-choice surveys (n=10, n=6) and open-ended questions (n=11, n=7) at baseline and follow-up. GAS acceptability was scored, with higher scores representing greater acceptability. Data were analyzed using Mann-Whitney tests, and open-ended responses were analyzed thematically.

RESULTS: Participants set a total of 71 goals [range=1-4]. There was no statistically significant difference between the number of goals set between participants who used an inventory (x̄=2.9) and those who did not (x̄=2.5; p=0.13) or between the acceptability of inventory-facilitated (1.15±0.25; 1.27±0.34) and standard GAS (0.96±0.24; 1.42±0.33) at baseline (p=0.12) or follow-up (p=0.35) respectively. Setting treatment goals resulted in a better-than-usual relationship with the clinician independent of goal inventory use. An enhanced understanding of the scope of treatment and increased perceptions of being cared for by the clinician were commonly noted, but only for inventory users.

CONCLUSIONS: Utilizing an inventory during goal setting to standardize the implementation of GAS is acceptable. However, future work is needed to assess its impact on the goal type, goal scale quality, and the time taken to develop GAS scales and facilitate its use across the phases of drug development.