A systematic review of goal attainment scaling implementation practices by caregivers in randomized controlled trials

Abstract

Background Goal attainment scaling (GAS), an established individualized, patient-centred outcome measure, is used to capture the patient’s voice. Although first introduced ~60 years ago, there are few published guidelines for implementing GAS, and almost none for its use when caregivers GAS is implemented with caregiver input. We conducted a systematic review of studies that implemented GAS with caregiver input; and examined variations in GAS implementation, analysis, and reporting. Methods Literature was retrieved from Medline, Embase, Cochrane, PsycInfo and CINAHL databases. We included randomized controlled trials (published between 1968 and November 2022) that used GAS as an outcome measure and involved caregiver input during goal setting. Results Of the 2610 studies imported for screening, 21 met the inclusion criteria. Most studies employed GAS as a primary outcome. The majority (76%) had children as study participants. The most common disorders represented were cerebral palsy, developmental disorders, and dementia/Alzheimer’s disease. The traditional five-point GAS scale, with levels from −2 to +2, was most often implemented, with −1 level typically being the baseline. However, most studies omitted essential GAS details from their reports including the number of goals set, number of attainment levels and whether any training was given to GAS facilitators. Conclusions GAS with caregiver input has been used in a limited number of randomized controlled trials, primarily in pediatric patients and adults with dementia. There is a variability in GAS implementation and many crucial details related to the specifics of GAS implementation are omitted from reports, which may limit reproducibility. Here we propose catalog that may be utilized when reporting research results pertaining to GAS with caregivers to enhance the application of this patient-centered outcome measure.

Personalized goals of people living with dementia and family carers: A content analysis of goals set within an individually tailored psychosocial intervention trial

“…GAS involves identifying problems and priorities, as well as defining, setting, and rating goals—a more complex cognitive process than more standardized outcome measures, leading to concerns it may be impractical in clinical practice, 9 and may lack methodological specification. 10 , 11 Though not tied to one specific methodology, GAS requires formulation of well‐written, specific, measurable, attainable, relevant, and time‐bound (SMART) goals. GAS has been used successfully with people living with dementia (PLWD) 10 , 12 , 13 , 14 , 15 , 16 and their family carers 17 , 18 , 19 to detect small, clinically important intervention effects up to 12 months.…”