Goal Elicitation Research Articles

This Month in Adult Urology

This Month in Adult Urology

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Jul 2019Editorial CommentThis article comments on the following:Development of a Goal Elicitation Measure to Support Choice about Urinary Diversion by Patients with Bladder Cancer Pauline Filippou, and Angela B. Smith Pauline FilippouPauline Filippou Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author , and Angela B. SmithAngela B. Smith Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557780.11159.91AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 202(1), p. 89 Reference 1. : Inferring bladder cancer research prioritization from patient-generated online content. World J Urol 2018; doi: 10.1007/s00345-018-2479-0. Crossref, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyJun 7, 2019, 5:00:07 AMDevelopment of a Goal Elicitation Measure to Support Choice about Urinary Diversion by Patients with Bladder Cancer Volume 202Issue 1July 2019Page: 89-89 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pauline Filippou Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author Angela B. Smith Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author Expand All Advertisement Loading ...

Development of a Goal Elicitation Measure to Support Choice about Urinary Diversion by Patients with Bladder Cancer.

Patient centered care aims to align treatment with patient goals, especially when treatment options have equivalent clinical outcomes. For surgeries with lasting impacts that alignment is critical. To our knowledge no psychometrically tested preference elicitation measures exist to support patients with bladder cancer treated with cystectomy, who can often choose between ileal conduit and neobladder diversions. In this study we created a scale to measure how patient goals align with each type of urinary diversion and the associated surgical outcomes. We performed formative research through focus groups and clinician outreach to adapt a goal dissonance measure. We mailed a survey to adult Kaiser Permanente® members who underwent cystectomy for bladder cancer between January 2013 and June 2015. Eligible patients were identified through electronic health records and chart review. Surveys were mailed 5 to 7 months postoperatively. We administered our 10-item decision dissonance scale along with other decision making measures. We explored goal alignment as well as dissonance. Psychometric analysis included factor analysis, evaluation of scale scores between surgery groups and evaluation with other decision making scores. We identified 10 goals associated with ileal conduit or neobladder diversion. Using survey data on 215 patients our scale differentiated patient goals associated with each diversion choice. On average patients with a neobladder strongly valued neobladder aligned goals such as maintaining body integrity and volitional voiding through the urethra. Patients with an ileal conduit had neutral values on average across all goals. Our measure lays the foundation for a simple value elicitation approach which could facilitate shared decision making about urinary diversion choice.

Harm reduction treatment for smoking (HaRT-S): findings from a single-arm pilot study with smokers experiencing chronic homelessness

Background: Smoking prevalence and mortality is 5 times higher for the chronically homeless versus general population. Unfortunately, traditional smoking cessation treatment does not optimally engage this population. In a preliminary study, smokers experiencing chronic homelessness suggested providers avoid giving advice to quit and instead use a more compassionate, nonjudgmental style to discuss a broader menu of patient-driven options, including safer nicotine use. Most had negative perceptions of smoking cessation medications; however, 76% expressed interest in a switchover to electronic nicotine delivery systems (ENDS). Methods: Using a community-based participatory research approach, we codeveloped harm-reduction treatment for smoking (HaRT-S) together with people with lived experience of chronic homelessness and smoking and a community-based agency that serves them. In HaRT-S, interventionists embody a compassionate, advocacy-oriented “heart-set” and deliver manualized components: a) participant-led tracking of smoking-related outcomes, b) elicitation of harm-reduction goals and progress made toward them, c) discussion of relative risks of nicotine delivery systems, and d) distribution and instructions on use of safer nicotine products. We then conducted a single-arm, 14-week pilot of HaRT-S (N = 44). Results: Participants rated procedures “totally acceptable/effective,” which was reflected in 26% overrecruitment within a 4-month period and 70% retention at the 14-week follow-up. For each week in the study, participants experienced an 18% increase in odds of reporting 7-day, biochemically verified, point-prevalence abstinence. All participants reporting abstinence used ENDS. Participants evinced reductions in cigarette dependence (−45%), frequency (-29%), and intensity (−78%; ps < .05). Participants who used ENDS experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not. Conclusions: Harm-reduction counseling plus ENDS shows promise for smokers experiencing chronic homelessness. Randomized controlled trials are needed to establish the efficacy of this approach in decreasing smoking-related harm and improving health-related quality of life for this marginalized and disproportionately affected population.

Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder

BackgroundPeople experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. MethodsPeople experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. ResultsCompared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). ConclusionA low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.

Systematic modeling of objectives and identification of reference system elements in a predevelopment project

Key factors for success of predevelopment projects are, among others, continuous validation and consensus building on objectives and the recurrent review thereof as well as the reduction of uncertainty in predevelopment projects.This research evaluates the usage and added value of a systematic approach to explicitly model objectives during a predevelopment project. Thereby, providing insights into the elicitation, organization and validation of goals, requirements, constraints and their interrelations. The awareness, recurrent update and review of these by all members of the engineering team is crucial. Therefore, this research investigates consensus-building on objectives regarding the work setting and the explicit modeling of objectives. A main finding is that physical proximity of the members of the engineering teams has a critical influence on the consensus building regarding objectives. The ability of direct communication mitigates the perceived added value of the systematic modeling of objectives in this predevelopment project. Hence, the modeling of objectives does not support the consensus building with an adequate effort-benefit ratio. The software supported modeling of objectives is tested in a live-lab setting with seven product engineering teams with five to six members each as well as engineers from an industrial partner and a research facility. All members of the teams are regularly audited in milestones, dedicated interviews and workshops.In this predevelopment project reference system elements are used to address the issue of uncertainty as reference system elements can be used to classify and manage necessary changes. As of now there is an eminent lack of methodology to support the identification of reference system elements aside of the predecessor and parts thereof. Several approaches to identify reference system elements used in this predevelopment project are collected with focus on methods utilizing objectives. The methods are categorized and the influence of modeling objectives on the method usage is discussed.

Patient goals in rheumatoid arthritis care: A systematic review and qualitative synthesis.

During the clinical encounter, rheumatoid arthritis (RA) patient goals for care often go unexplored. The aim of the present systematic review was to identify needs, goals and expectations of RA patients in order better to guide systematic elicitation of patient goals in clinical encounters. An academic librarian searched MEDLINE, PsychINFO and the Cochrane Library using a specialized algorithm developed to identify articles about patient goals for RA care. Investigators screened search results according to prespecified inclusion criteria and then reviewed included articles and synthesized the evidence qualitatively, utilizing an inductive approach. A total of 909 titles were retrieved in the literature search, of which 871 were excluded after a title/abstract screen. Of the remaining 38, 22 papers were included in the final review. Investigators identified four major themes in the literature: (a) the bodily experience of RA; (b) achieving normalcy and maintaining wellness; (c) social connectedness and support; and (d) interpersonal and healthcare system interactions. Patients' goals when receiving care for RA are multidimensional and span several facets of everyday life. Goals for RA care should be collaboratively developed between patients and providers, with particular attention to the patient's life context and priorities.

Patient Health Goals Elicited During Home Care Admission: A Categorization.

Home care agencies are initiating "patient health goal elicitation" activities as part of home care admission planning. We categorized elicited goals and identified "clinically informative" goals at a home care agency. We examined patient goals that admitting clinicians documented in the point-of-care electronic health record; conducted content analysis on patient goal data to develop a coding scheme; grouped goal themes into codes; assigned codes to each goal; and identified goals that were in the patient voice. Of the 1,763 patient records, 16% lacked a goal; only 15 goals were in a patient's voice. Nurse and physician experts identified 12 of the 20 codes as clinically important accounting for 82% of goal occurrences. The most frequent goal documented was safety/falls (23%). Training and consistent communication of the intent and operationalization of patient goal elicitation may address the absence of patient voice and the less than universal recording of home care patients' goals.

A structured hazard analysis and risk assessment method for automotive systems—A descriptive study

The 2011 release of the first version of the ISO 26262 standard for automotive systems demand the elicitation of safety goals following a rigorous method for hazard and risk analysis. Companies are struggling with the adoption of the standard due to ambiguities, documentation demands and the alignment of the standards demands to existing processes. We previously proposed a structured engineering method to deal with these problems developed in applying action research together with an OEM. In this work, we evaluate how applicable the method is for junior automotive software engineers by a descriptive study. We provided the method to 8 members of the master course Automotive Software Engineering (ASE) at the Technical University Munich. The participants have each been working in the automotive industry for 1–4 years in parallel to their studies. We investigated their application of our method to an electronic steering column lock system. The participants applied our method in a first round alone and afterwards discussed their results in groups. Our data analysis revealed that the participants could apply the method successfully and the hazard analysis and risk assessment achieved a high precision and productivity. Moreover, the precision could be improved significantly during group discussions.

NLP-KAOS for Systems Goal Elicitation: Smart Metering System Case Study

This paper presents a computational method that employs Natural Language Processing (NLP) and text mining techniques to support requirements engineers in extracting and modeling goals from textual documents. We developed a NLP-based goal elicitation approach within the context of KAOS goal-oriented requirements engineering method. The hierarchical relationships among goals are inferred by automatically building taxonomies from extracted goals. We use smart metering system as a case study to investigate the proposed approach. Smart metering system is an important subsystem of the next generation of power systems (smart grids). Goals are extracted by semantically parsing the grammar of goal-related phrases in abstracts of research publications. The results of this case study show that the developed approach is an effective way to model goals for complex systems, and in particular, for the research-intensive complex systems.

Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making

To use observation to understand how decisions about higher-risk treatments, such as biologics, are made in pediatric chronic conditions. Gastroenterology and rheumatology providers who prescribe biologics were recruited. Families were recruited when they had an outpatient appointment in which treatment with biologics was likely to be discussed. Consent/assent was obtained to video the visit. Audio of the visits in which a discussion of biologics took place were transcribed and analyzed. Our coding structure was based on prior research, shared decision making (SDM) concepts, and the initial recorded visits. Coded data were analyzed using content analysis and comparison with an existing model of SDM. We recorded 21 visits that included discussions of biologics. In most visits, providers initiated the decision-making discussion. Detailed information was typically given about the provider's preferred option with less information about other options. There was minimal elicitation of preferences, treatment goals, or prior knowledge. Few parents or patients spontaneously stated their preferences or concerns. An implicit or explicit treatment recommendation was given in nearly all visits, although rarely requested. In approximately one-third of the visits, the treatment decision was never made explicit, yet steps were taken to implement the provider's preferred treatment. We observed limited use of SDM, despite previous research indicating that parents wish to collaborate in decision making. To better achieve SDM in chronic conditions, providers and families need to strive for bidirectional sharing of information and an explicit family role in decision making.

ENHANCING GOAL-ORIENTED SECURITY REQUIREMENTS ANALYSIS USING COMMON CRITERIA-BASED KNOWLEDGE

Goal-oriented requirements analysis (GORA) is one of the promising techniques to elicit software requirements, and it is natural to consider its application to security requirements analysis. In this paper, we proposed a method for goal-oriented security requirements analysis using security knowledge which is derived from several security targets (STs) compliant to Common Criteria (CC, ISO/IEC 15408). We call such knowledge security ontology for an application domain (SOAD). Three aspects of security such as confidentiality, integrity and availability are included in the scope of our method because the CC addresses these three aspects. We extract security-related concepts such as assets, threats, countermeasures and their relationships from STs, and utilize these concepts and relationships for security goal elicitation and refinement in GORA. The usage of certificated STs as knowledge source allows us to reuse efficiently security-related concepts of higher quality. To realize our proposed method as a supporting tool, we use an existing method GOORE (goal-oriented and ontology-driven requirements elicitation method) combining with SOAD. In GOORE, terms and their relationships in a domain ontology play an important role of semantic processing such as goal refinement and conflict identification. SOAD is defined based on concepts in STs. In contrast with other goal-oriented security requirements methods, the knowledge derived from actual STs contributes to eliciting security requirements in our method. In addition, the relationships among the assets, threats, objectives and security functional requirements can be directly reused for the refinement of security goals. We show an illustrative example to show the usefulness of our method and evaluate the method in comparison with other goal-oriented security requirements analysis methods.

Elaborating Requirements Using Model Checking and Inductive Learning

The process of Requirements Engineering (RE) includes many activities, from goal elicitation to requirements specification. The aim is to develop an operational requirements specification that is guaranteed to satisfy the goals. In this paper, we propose a formal, systematic approach for generating a set of operational requirements that are complete with respect to given goals. We show how the integration of model checking and inductive learning can be effectively used to do this. The model checking formally verifies the satisfaction of the goals and produces counterexamples when incompleteness in the operational requirements is detected. The inductive learning process then computes operational requirements from the counterexamples and user-provided positive examples. These learned operational requirements are guaranteed to eliminate the counterexamples and be consistent with the goals. This process is performed iteratively until no goal violation is detected. The proposed framework is a rigorous, tool-supported requirements elaboration technique which is formally guided by the engineer's knowledge of the domain and the envisioned system.

A pilot cluster randomized controlled trial of structured goal-setting following stroke

Objective: To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting. Design: A cluster randomized controlled trial. Setting: Inpatient rehabilitation facilities. Subjects: People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure. Interventions: Structured goal elicitation using the Canadian Occupational Performance Measure. Main measures: Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention. Results: Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design. Conclusions: A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.

A Method for Eliciting Goals for Business Process Models based on Non-Functional Requirements Catalogues

While traditional approaches in business process modeling tend to focus on “how” the business processes are performed (adopting a behavioral description in which business processes are described in terms of procedural aspects), in goal-oriented business process modeling, the proposals strive to extend traditional business process methodologies by providing a dimension of intentionality to business processes. One of the key difficulties in enabling one to model goal-oriented processes concerns the identification or elicitation of goals. This paper reports on a case study conducted in a Brazilian hospital, which obtained several goal models represented in i*/Tropos, each of which correspond to a business process also modeled in the scope of the study. NFR catalogues were helpful in goal elicitation, uncovering goals that did not come up during previous interviews prior to these catalogues’ use.

Goal attainment scaling in patients with lower urinary tract symptoms: development and pilot testing of the Self-Assessment Goal Achievement (SAGA) questionnaire

The Self-Assessment Goal Achievement (SAGA) questionnaire was developed to identify treatment goals and assess goal-achievement in patients with lower urinary tract symptoms (LUTS). This study consisted of (1) gathering information on goal setting/attainment concepts, (2) goal elicitation (n = 41 patients with LUTS), (3) cognitive debriefing of draft questionnaire (n = 11), and (4) pilot testing (n = 104). SAGA consists of baseline (goal-assessment; ranking) and follow-up (goal-achievement) modules. In addition to goals most frequently mentioned, patients can list up to five open goals. Goals most commonly reported as "very important" in pilot testing included reducing urgency (72%), incontinence (65%), and nocturia (64%). Treatment goals spontaneously reported as "very important" were reducing incontinence (45%), nocturia (40%), and frequency (26%). SAGA may be used to identify treatment goals and assess goal-achievement in patients with LUTS in the clinic and for research (with additional validation). This information may promote patient-physician interaction and help patients establish realistic treatment goals, which may in turn improve treatment adherence and outcomes.

Using abduction and induction for operational requirements elaboration

Requirements Engineering involves the elicitation of high-level stakeholder goals and their refinement into operational system requirements. A key difficulty is that stakeholders typically convey their goals indirectly through intuitive narrative-style scenarios of desirable and undesirable system behaviour, whereas goal refinement methods usually require goals to be expressed declaratively using, for instance, a temporal logic. In actual software engineering practice, the extraction of formal requirements from scenario-based descriptions is a tedious and error-prone process that would benefit from automated tool support. This paper presents an Inductive Logic Programming method for inferring operational requirements from a set of example scenarios and an initial but incomplete requirements specification. The approach is based on translating the specification and the scenarios into an event-based logic programming formalism and using a non-monotonic reasoning system, called eXtended Hybrid Abductive Inductive Learning, to automatically infer a set of event pre-conditions and trigger-conditions that cover all desirable scenarios and reject all undesirable ones. This learning task is a novel application of logic programming to requirements engineering that also demonstrates the utility of non-monotonic learning capturing pre-conditions and trigger-conditions.

Improving the detection of requirements discordances among stakeholders

This paper introduces a technique to identify requirements discordances among stakeholders. This technique is validated in experiments. An extended version of the goal-oriented requirements elicitation method, named attributed goal-oriented analysis (AGORA), and its supporting tool are used. Two types of requirements discordances among stakeholders are defined: the first arises from the different interpretations by the stakeholders and the second is the result of different evaluations of preferences. Discordances are detected by the preference matrices in AGORA. Each preference matrix represents both preferences of each stakeholder and the estimated preferences of other stakeholders. A supporting tool for the AGORA method was developed. This tool is a groupware that seamlessly combines face-to-face meetings for goal elicitation and distributed individual sessions for scoring preference values. The experimental results showed that the proposed classification of discordances was sound and that the occurrences of the requirements discordances could be detected by preference matrices.

Applying Personal Construct Theory to Requirements Elicitation

One of the main approaches to Requirements Engineering is Goal-Oriented Requirement Engineering. This approach, based in Artificial Intelligence models, argues that goals are a natural and high level abstraction concept to elicit and represent requirements. Another advantage of goals is that they help non-functional requirements representation and reasoning. Although the goal oriented approach helps in representation and analysis, the problem of eliciting goals and their refinement is not trivial. In this article, we explore several applications to goal elicitation using a psychological theory: the Personal Construct Theory (PCT). This theory, stated by Kelly in 1955, can be used to elicit goals and their relationships. The choice of this theory is based in that it has a statistical base, therefore it is more precise and user independent than others. Finally, PCT can be amenable to automation by means of the Repertory Grid technique, widely studied in the Knowledge eliciting field.

Handling obstacles in goal-oriented requirements engineering

Requirements engineering is concerned with the elicitation of high-level goals to be achieved by the envisioned system, the refinement of such goals and their operationalization into specifications of services and constraints and the assignment of responsibilities for the resulting requirements to agents such as humans, devices and software. Requirements engineering processes often result in goals, requirements, and assumptions about agent behavior that are too ideal; some of them are likely not to be satisfied from time to time in the running system due to unexpected agent behavior. The lack of anticipation of exceptional behaviors results in unrealistic, unachievable, and/or incomplete requirements. As a consequence, the software developed from those requirements will not be robust enough and will inevitably result in poor performance or failures, sometimes with critical consequences on the environment. This paper presents formal techniques for reasoning about obstacles to the satisfaction of goals, requirements, and assumptions elaborated in the requirements engineering process. The techniques are based on a temporal logic formalization of goals and domain properties; they are integrated into an existing method for goal-oriented requirements elaboration with the aim of deriving more realistic, complete, and robust requirements specifications. A key principle is to handle exceptions at requirements engineering time and at the goal level, so that more freedom is left for resolving them in a satisfactory way. The various techniques proposed are illustrated and assessed in the context of a real safety-critical system.