Personal Treatment Goals Research Articles

Impact of chemotherapy-induced peripheral neuropathy permanence on patients' preference to discontinue chemotherapy.

12046 Background: Chemotherapy-induced peripheral neuropathy (CIPN) diminishes patients’ functional ability and quality of life; approximately 40% of patients experience CIPN symptoms 3 years after treatment. Due to the absence of effective CIPN treatments, ASCO guidelines recommend discontinuing chemotherapy in patients experiencing intolerable CIPN symptoms. Little is known about patient’s preference to continue or discontinue chemotherapy when experiencing CIPN, and whether the potential permanence of CIPN symptoms affects this decision. The objective of this prospective observational study was to determine the effect of CIPN symptom permanence on patients’ preference to discontinue chemotherapy. Methods: Patients receiving taxane and/or platinum chemotherapy for breast or colorectal cancer were enrolled in a prospective observational clinical study. Patients reported their CIPN severity using the EORTC CIPN20 patient-reported outcome questionnaire at the start of each treatment cycle. At the same time, patients were asked if they would prefer to continue or discontinue chemotherapy treatment under the hypothetical scenario that their current CIPN symptoms would be temporary or permanent. A generalized linear mixed effects model was used to determine the effect of CIPN severity, permanence, and other clinical variables on a patient’s decision to discontinue (vs. continue) chemotherapy treatment. Results: A total of 66 patients completed data collection at least one time, of whom 55 (83%) had breast cancer, 12 (18%) had metastatic disease, and 52 (79%) received a taxane. The odds a patient would prefer to discontinue chemotherapy treatment if their CIPN symptoms would be permanent (vs. temporary) were nearly 30 times greater (odds ratio (OR)=30.15, 95% confidence interval (CI): 15.73-57.79, p<0.001, Table). There was a statistical trend toward preferring to discontinue chemotherapy treatment as CIPN symptom severity increased (OR=1.09, 95% CI: 1.00-1.19, p=0.063). Conclusions: The potential for CIPN symptoms to be permanent has a huge effect on whether patients want to continue or discontinue chemotherapy treatment. Additional data is needed on the incidence and predictors of permanent CIPN. More importantly, shared decision-making tools that convey the risk of permanent CIPN, and the potential risk of discontinuing chemotherapy treatment, are needed to facilitate patient-centered treatment decisions so that each patient with cancer achieves their personal treatment goals. [Table: see text]

Estimating Efficacy of Conversion Therapy on Patients with Initially Unresectable Colorectal Cancer Liver Metastases by using MRI: Development of a Predictive Score

The conversion success rate (CSR) has crucial implication for clinical outcomes of initially unresectable colorectal liver metastases (CRLM) following conversion therapy. This study aimed to develop a simple predictive scoring model for identifying CSR according to baseline magnetic resonance imaging (MRI) features, and confirm its performance and prognostic significance in a validation cohort. A total of 155 consecutive patients with initially unresectable CRLM were retrospectively reviewed in the study. A simple MRI-based predictive scoring model for identifying CSR was developed in the development cohort (n=104) by using multivariable logistic regression analyzes. The diagnostic performance was evaluated for the predictive score. Thereafter, patients in the validation cohort (n=51) were stratified into groups with predicted high CSR or low CSR according to the score. The progression-free survival (PFS) and overall survival (OS) were compared between two groups using the log-rank test. The predictive score of CSR, named mrNISE, incorporated the number of CRLM ≥10, the largest size ≥50mm, poorly defined tumor-liver interface, and peritumoral enhancement. The AUC of the mrNISE score was 0.845 for the development cohort and 0.776 for the validation cohort. According to the score, patients with predicted high CSR had better PFS and OS than those with low CSR in both development and validation cohorts. The predictive score demonstrated great performance for identifying CSR of initially unresectable CRLM. Stratifying patients by the score, personalized treatment goals can be formulated before conversion therapy to improve clinical prognosis and reduce adverse events caused by ineffective treatment.

Терапевтические возможности и перспективы самоконтроля гликемии – неотъемлемого компонента управления сахарным диабетом

Diabetes mellitus (DM) is one of the global problems of world’s healthcare. Systemic vascular complications are the dangerous sequelae of the disease, and chronic hyperglycemia is the leading factor contributing to the disease development. Glycemic control remains an effective strategy to prevent diabetes complications that requires achieving and maintaining metabolic targets throughout the life of the patient. The current guidelines on the selection of personalized treatment goals based on the glycated hemoglobin (HbA1c) levels and the glycemic control methods are discussed. The emphasis is placed on self-monitoring of blood glucose (SMBG), one of the important factors contributing to the efficacy of the ongoing glucose-lowering therapy and hypoglycemia prevention. Proper SMBG is impossible without therapeutic training of DM patients. The current understanding of SMBG implies a certain frequency of the systematic measurement of blood glucose levels depending on the DM type and the type of glucose-lowering therapy. Various glucose meters for measurement of blood glucose levels at home are available. The criteria for choosing the glucose meter include compliance with the relevant accuracy standards, simplicity and ease of use, ease of getting the results by patients, which allow patients of any age to easily measure blood glucose levels. With all the advancements in modern technology, the glucose meters have appeared that significantly expand the possibilities of DM control due to integration with the free mobile application.

Imaging of Pheochromocytomas and Paragangliomas.

Pheochromocytomas/paragangliomas are unique in their highly variable molecular landscape driven by genetic alterations, either germline or somatic. These mutations translate into different clusters with distinct tumor locations, biochemical/metabolomic features, tumor cell characteristics (eg, receptors, transporters), and disease course. Such tumor heterogeneity calls for different imaging strategies in order to provide proper diagnosis and follow-up. This also warrants selection of the most appropriate and locally available imaging modalities tailored to an individual patient based on consideration of many relevant factors including age, (anticipated) tumor location(s), size, and multifocality, underlying genotype, biochemical phenotype, chance of metastases, as well as the patient's personal preference and treatment goals. Anatomical imaging using computed tomography and magnetic resonance imaging and functional imaging using positron emission tomography and single photon emission computed tomography are currently a cornerstone in the evaluation of patients with pheochromocytomas/paragangliomas. In modern nuclear medicine practice, a multitude of radionuclides with relevance to diagnostic work-up and treatment planning (theranostics) is available, including radiolabeled metaiodobenzylguanidine, fluorodeoxyglucose, fluorodihydroxyphenylalanine, and somatostatin analogues. This review amalgamates up-to-date imaging guidelines, expert opinions, and recent discoveries. Based on the rich toolbox for anatomical and functional imaging that is currently available, we aim to define a customized approach in patients with (suspected) pheochromocytomas/paragangliomas from a practical clinical perspective. We provide imaging algorithms for different starting points for initial diagnostic work-up and course of the disease, including adrenal incidentaloma, established biochemical diagnosis, postsurgical follow-up, tumor screening in pathogenic variant carriers, staging and restaging of metastatic disease, theranostics, and response monitoring.

Patients’ perspectives on tapering programmes for prescription opioid use disorder: a qualitative study

ObjectivesApproximately 10% of chronic pain patients who receive opioids develop an opioid use disorder (OUD). Tapering programmes for these patients show high drop-out rates. Insight into chronic pain patients’ experiences...

International Classification of Functioning, Disability, and Health-based rehabilitation program promotes activity and participation of post-stroke patients.

The International Classification of Functioning, Disability, and Health (ICF) model has been applied in post-stroke rehabilitation, yet limited studies explored its clinical application on enhancing patients' Activity and Participation (ICF-A&P) level. This study gathered evidence of the effects of an ICF-based post-stroke rehabilitation program (ICF-PSRP) in enhancing community reintegration in terms of ICF-A&P of post-stroke patients. Fifty-two post-stroke patients completed an 8 to 12 weeks multidisciplinary ICF-PSRP after setting personal treatment goals in an outpatient community rehabilitation center. Intake and pre-discharge assessments were administered for primary outcomes of Body function (ICF-BF; e.g., muscle strength) and ICF-A&P (e.g., mobility), and secondary outcomes of perceived improvements in ability (e.g., goal attainment and quality of life). There were significantly higher levels in the ICF-BF and ICF-A&P domains, except cognitive function under the ICF-BF. Improvements in the primary outcomes predicted corresponding secondary outcomes. Firstly, expressive and receptive functions (ICP-BF) were mediated by the everyday language (ICF-A&P) which predicted patients' satisfaction with the language-related quality of life. Secondly, upper extremity function (ICP-BF) was mediated by the lower extremity mobility (ICF-A&P) predicting work and productivity-related quality of life. Content analyses showed that combined ICF-BF and ICF-A&P contents throughout the ICF-PSRP contributed to the positive treatment effects. The ICF-PSRP was effective in promoting body function, and activity and participation levels of post-stroke patients. Positive treatment effects are characterized by goal-setting process, cross-domain content design, and community-setting delivery.Clinical trial registration: https://clinicaltrials.gov/study/NCT05941078?id=NCT05941078&rank=1, identifier NCT05941078.

Goal Attainment Scale in tinnitus (GAS-T): treatment goal priorities by chronic tinnitus patients in a real-world setting.

Standard treatment for tinnitus is cognitive behavioral therapy, although level of evidence of effectiveness is low. There is need for a Goal Attainment Scale to evaluate treatment effects based on patient satisfaction. Preliminary work in a clinical sample has identified six common personal treatment goals. The purpose of this study is to determine whether the preliminary identified goals are confirmed by a heterogeneous sample of people with bothersome tinnitus and to identify any other common personal goals with the intention to construct a closed-end Goal Attainment Scale for tinnitus for use in research of effectiveness of (new) tinnitus treatments. Two consecutive polls were plotted in an online peer support group form a heterogeneous sample. First, members were asked to vote for preliminary identified goals and asked to formulate additional personal goals. Corresponding goals were grouped together. Goals that were acknowledged by at least 10% of respondents were used in the second poll in which respondents could vote for statements that they recognized themselves in. The first poll (N = 180) resulted in 15 personal treatment goals. Comparison resulted in five common goals, which were confirmed in the second poll (N = 238): to gain control, to improve well-being and sleep, to reduce effects on hearing and to understand tinnitus. We expect that if a patient achieves personal goals, he will be likely to reduce healthcare consumption. Based on commonpersonal goals, validity of treatment evaluations is increased. We present a closed-end Goal Attainment Scale in tinnitus.

ID: 209974 Improved Trial Success Using a Novel Patient App for Goal Setting and Digital Education Resources

Recent data has demonstrated that use of a novel digital health application during the SCS trial correlates with improved trial outcomes and shows high patient engagement with the application throughout the trial.1 Enhancing trial success provides an opportunity to give more patients access to SCS therapy, and benefits patients, providers, and payors alike. It is thought that patient education and goal setting play a key role in SCS patient success, both for the trial and implant. However, patients may experience a lack of timely access to appropriate educational resources or may find misleading information through online search.2 Additionally, though individual patient goals are varied, they may not be prompted to set a personalized goal for the trial, and instead focus solely on the standard criteria of pain relief.3 These present potential barriers to treatment success for SCS patients. Thankfully, new digital applications have been developed with patient education and goal setting in mind to provide timely access to quality educational resources and the ability to set personalized treatment goals. In this abstract we explore the impact of viewing educational resources and setting personalized goals in a SCS patient trial application on trial outcomes.

China guideline for diagnosis and comprehensive treatment of colorectal liver metastases (version 2023)

The liver is the main target organ for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment of colorectal liver metastasis in China, the guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised guideline version 2023 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, with state-of-the-art experience and findings, detailed content, and strong operability.

Qualitative evaluation of the acceptability and feasibility among healthcare professionals and patients of an ART multi-cycle treatment planning and continuation intervention prototype.

Is it possible to design an ART Treatment Planning and Continuation Intervention (TPCI) that is considered acceptable and feasible to patients and healthcare professionals (HCPs)? HCPs and patients responded positively to the TPCI prototype and perceived it as an acceptable intervention to support patients to stay engaged with planned treatment, but some concerns were raised about the feasibility of using it in practice. People discontinue ART due to its psychological burden. Digital tools to support people undergoing ART are available but typically focus only on practical support rather than psychological support. Research about treatment continuation and multi-cycle planning indicates that cognitive factors (expectations, intentions, efficacy beliefs) should be targets of interventions designed to help patients engage with and continue treatment to meet their personal treatment plans and goals. However, it is not known whether this form of psychological support would be acceptable for HCPs and patients or feasible to implement in practice. Qualitative cognitive interviews with HCPs and patients (May 2021). Patients were eligible if they had had a consultation to start a first/repeat stimulated IVF/ICSI cycle in the 8 weeks prior to recruitment, were aged 18 or older (upper age limit of 42 years for women) and fluent in English. Eligible HCPs were those employed by a fertility clinic who were responsible for delivering treatment planning consultations to patients. HCPs and patients were asked to think aloud while being exposed to and exploring the TPCI in one-to-one online cognitive interviews. The TPCI was designed to reduce treatment discontinuation via cognitive factors namely formation and maintenance of multi-cycle ART intentions and efficiency of decision-making during treatment, and continuation of treatment after an unsuccessful cycle (when recommended). To impact cognitive factors the TPCI comprised of two components: an expectation management and reasoning checklist for HCPs to use during planning consultations (TPCI Checklist) and a multi-feature cognitive support mobile application (TPCI App) for patients to use prior to and during treatment. After participants thought aloud while being exposed to the TPCI prototype (both components) they were asked open questions concerning their perceptions of the core components and activities on eight acceptability dimensions (e.g. acceptability, demand, integration). Interviews lasted between 40 and 90 min, were recorded, transcribed verbatim and analysed using thematic analysis. Thirteen HCPs and 13 patients participated in 25 online interviews. Thematic analysis using inductive and deductive coding generated 180 codes, grouped into 22 categories and synthesized into 9 themes. The themes showed that HCPs and patients provided positive feedback about the TPCI, perceiving it as a needed, acceptable and potentially effective way to forewarn patients of the possible need for multiple cycles, to provide patients with a sense of patient-clinic collaboration and support, and to bolster treatment intentions, all of which were perceived to contribute to reduced treatment discontinuation. HCPs perceived implementation of the TPCI Checklist to be challenging in its current length due to time pressures and clinic workload. Suggestions for enhancing the TPCI Checklist and App were provided, but none required critical changes to its core components or activities. All patients were women recruited from social media websites, mainly associated with patient support groups, who may be highly committed to their fertility treatment. HCPs were predominantly from private fertility clinics. The findings suggest there is demand for digital support geared towards motivational aspects of undergoing ART. The TPCI is an acceptable support tool to meet that need according to HCPs responsible for delivering planning consultations and patients undergoing fertility treatment. Future research is needed to develop the prototype and examine the feasibility of implementation of the TPCI in clinics. This research was financially supported by Merck Serono Ltd, an affiliate of Merck KGaA, Darmstadt, Germany. 'Merck KGaA, Darmstadt, Germany reviewed the manuscript for medical accuracy only before journal submission. The authors are fully responsible for the content of this manuscript, and the views and opinions described in the publication reflect solely those of the authors' J.B. reports personal fees from Merck KGaA, Darmstadt, Germany, Merck AB an affiliate of Merck KGaA, Darmstadt Germany, Theramex, Organon JJC, Ferring Pharmaceuticals A/S, research grant from Merck Serono Ltd, grants from ESHRE outside the submitted work and that she is co-developer of Fertility Quality of Life (FertiQoL) and MediEmo app. S.G. reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter. C.H. declares no conflicts of interest. N/A.

Making space for patients’ preferences in precision medicine: a qualitative study exploring perspectives of patients with rheumatoid arthritis

ObjectivePrecision medicine in rheumatoid arthritis (RA) creates new opportunities to involve patients in early identification of accurate indicators of health trajectories. The aim of this study was to explore patient...

Attainment of personal goals in the first year of intrathecal baclofen treatment in dyskinetic cerebral palsy: a prospective cohort study

Purpose To assess attainment of individual treatment goals one year after intrathecal baclofen (ITB) pump implantation in individuals with dyskinetic cerebral palsy (CP). Materials and methods A multi-center prospective cohort study was conducted including 34 non-walking individuals with severe dyskinetic CP, classified as Gross Motor Function Classification System (GMFCS) IV/V, aged 4–24 years, 12 months after pump implantation. The main outcome measure was Goal Attainment Scaling (GAS). Predictors of GAS results were analyzed. Complications were registered systematically. Results Seventy-one percent of individuals with dyskinetic CP fully achieved one or more treatment goals. One or more treatment goals were partially achieved in 97% of individuals. Two factors were found to be associated with attainment of goals: Dyskinesia Impairment Scale (DIS) score at baseline and the difference in pain score between baseline and follow-up. These two variables explain 30% of the variance in the outcome. Conclusions Intrathecal baclofen is effective in achieving individual treatment goals in children and young adults with dyskinetic CP after nine to 12 months of ITB treatment. A positive outcome on treatment goals is, for a small part, associated with higher severity of dystonia at baseline and with improvement of pain during treatment. Clinical trial registration number Dutch Trial Register, number NTR3642. Implications for rehabilitation Intrathecal baclofen treatment is effective in attainment of personal treatment goals, one year after pump implantation in patients with dyskinetic cerebral palsy. A positive outcome on treatment goals is, for a small part, related to higher severity of dystonia at the start and on improvement of pain during treatment.

Does age matter? Initial treatment goals of older adults with major depression in outpatient cognitive behavioural therapy.

Personal treatment goals (PTG) are important means to tailor psychotherapy to the needs of the patient, leading to increased engagement and greater improvement in relevant outcomes. According to lifespan developmental research, motivational goals in old age differ from goals of younger people, with management of losses rather than growth becoming more prevalent. However, this study is the first to systematically investigate age-specific differences in PTGs. We used routine data from patients with major depression assessed at the beginning of outpatient cognitive behavioural therapy. Initial high-priority PTGs were assessed using the Bern Inventory of Treatment Goals (BIT-C). Older patients (≥60 years, n = 52) were matched to younger patients (<60 years, n = 52) with regard to severity of depression, number of comorbidities, gender and level of education. Using a mixed method approach, high-priority PTGs of both age groups were focused most strongly on reducing depressive symptoms and, subsequently, anxiety. At the same time, older patients focused more strongly on PTGs related to well-being and functioning, while younger patients' emphasis was on personal growth. Furthermore, better coping with the ageing process and physical losses emerged as important PTGs for some older patients. Initial PTG themes are specific to diagnosis, but also seem to differ in regard to age. Thus, it is important to develop age-sensitive measures that allow appropriate and efficient tailoring of psychotherapy to meet older patients' needs and preferences.

Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment

PurposeThis paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.Design/methodology/approachThe theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).FindingsThe systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.Research limitations/implicationsFuture research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.Practical implicationsTo implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.Social implicationsOTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.Originality/valueThe OTAT approach has not been described in the addiction treatment literature so far.

Aberrant triple-network connectivity patterns discriminate biotypes of first-episode medication-naive schizophrenia in two large independent cohorts.

Schizophrenia is a complex disorder associated with aberrant brain functional connectivity. This study aims to demonstrate the relation of heterogeneous symptomatology in this disorder to distinct brain connectivity patterns within the triple-network model. The study sample comprised 300 first-episode antipsychotic-naive patients with schizophrenia (FES) and 301 healthy controls (HCs). At baseline, resting-state functional magnetic resonance imaging data were captured for each participant, and concomitant neurocognitive functions were evaluated outside the scanner. Clinical information of 49 FES in the discovery dataset were reevaluated at a 6-week follow-up. Differential features between FES and HCs were selected from triple-network connectivity profiles. Cutting-edge unsupervised machine learning algorithms were used to define patient subtypes. Clinical and cognitive variables were compared between patient subgroups. Two FES subgroups with differing triple-network connectivity profiles were identified in the discovery dataset and confirmed in an independent hold-out cohort. One patient subgroup appearing to have more severe clinical symptoms was distinguished by salience network (SN)-centered hypoconnectivity, which was associated with greater impairments in sustained attention. The other subgroup exhibited hyperconnectivity and manifested greater deficits in cognitive flexibility. The SN-centered hypoconnectivity subgroup had more persistent negative symptoms at the 6-week follow-up than the hyperconnectivity subgroup. The present study illustrates that clinically relevant cognitive subtypes of schizophrenia may be associated with distinct differences in connectivity in the triple-network model. This categorization may foster further analysis of the effects of therapy on these network connectivity patterns, which may help to guide therapeutic choices to effectively reach personalized treatment goals.

Minimal important difference of change in patient-specific goals in severe emphysema patients.

Change in patient's personal treatment goals is an important patient-reported outcome and can be measured by the patient-specific complaints (PSC) questionnaire. This paper establishes the MID for this questionnaire as −5.9 points. https://bit.ly/3kwvWKM

Patient Satisfaction and Attainment of Patient-Specific Goals after Endobronchial Valve Treatment.

Rationale: Bronchoscopic lung volume reduction with endobronchial valves (EBVs) significantly improves clinical outcomes in patients with severe emphysema. However, patient-reported outcomes like patient satisfaction and patient-specific treatment goals were never investigated.Objectives: To investigate the patient-satisfaction level 1 year after treatment and patient-specific goals before and 1 year after EBV treatment. Furthermore, the study aimed to investigate whether the level of patient satisfaction or change in goals was associated with change in the clinical outcome.Methods: We prospectively included patients who underwent EBV treatment as part of regular care in our hospital and asked patients to report and score their personal treatment goals on the patient-specific complaint (PSC) questionnaire at baseline and after 1 year of follow-up and to complete a patient-satisfaction questionnaire at 1 year of follow-up.Results: Of the 134 patients who were treated with EBV, 109 filled out the patient-satisfaction questionnaire and 88 filled out the PSC questionnaire at baseline and 1 year after treatment. When adjusting for the patients who were lost to follow-up, 91% of the patients in total would recommend the EBV treatment to other patients. Seventy-five percent of the patients were (very) satisfied with the treatment and 11% were (very) unsatisfied. The three most frequently reported patient-specific goals to improve were walking (reported by 77% of the patients), taking a shower/washing/getting dressed (35%), and completing household chores (32%). Both the total PSC questionnaire sum score (mean change, -6.01 ± 6.0) and all individual reported goals significantly improved 1 year after treatment (P < 0.001). Furthermore, a higher patient-satisfaction level and larger improvement in goals was significantly associated with an improvement in forced expiratory volume in 1 second, residual volume, dyspnea severity, and quality of life.Conclusions: We found that the patient-satisfaction level is high and patient-specific goals significantly improve 1 year after EBV treatment. We believe that the individual patient's goals are important in the process of shared decision-making before treatment, as they can be used to identify unrealistic expectations beforehand and prevent disappointment afterward.Clinical trial registered at clinicaltrials.gov (NCT02815683).

The responsiveness of goal attainment scaling using just one goal in controlled clinical trials: an exploratory analysis

BackgroundGoal Attainment Scaling (GAS) is an individualized outcome measure that allows the setting of personalized treatment goals. We compared the responsiveness of GAS when individuals set only one goal instead of the recommended three or more goals.MethodsWe conducted exploratory analyses on data from two randomized controlled trials: the Video-Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) (n = 130); and the Mobile Geriatric Assessment Team (MGAT) (n = 265). Independent t-tests and standardized response means (SRMs) were used to assess responsiveness of one- vs. multiple-goal GAS.ResultsIn VISTA, clinician-rated multiple-goal GAS detected higher goal attainment in the intervention group (p = 0.01; SRM = 0.48). One-goal GAS, whether rated by patients or by clinicians, did not detect differences in goal attainment between groups (patient: p = 0.56, SRM = 0.10; clinician: p = 0.10, SRM = 0.29). In MGAT, multiple-goal GAS (outcome goals: p < .001, SRM = 1.29; total goals: p < .001, SRM = 1.52) and one-goal GAS (outcome goals: p < .001, SRM = 0.89; total goals: p < .001, SRM = 0.75), detected significantly higher goal attainment in the intervention group.ConclusionOne-goal GAS detected significant change in response to a patient-centred, multi-domain care initiative. As such, in similar contexts, one-goal GAS may be an effective means of optimizing personalization and improving GAS feasibility through reduced administration time. However, it is not yet clear if one-goal GAS is responsive in the context of a pharmacological intervention and further research is recommended.

Assessment methods and research status of quality of life in patients with nonalcoholic fatty liver disease

Over the past two decades, the incidence of non-alcoholic fatty liver disease (NAFLD) has risen sharply and has become the most common chronic liver disease, placing a heavy burden on patients and their families. A comprehensive assessment of the quality of life (QoL) of NAFLD patients is necessary to develop and implement more effective intervention strategies. Currently, the disease-specific scales commonly used to assess the quality of life of NAFLD patients include the 36-Item Short-Form Health Survey questionnaire (SF-36), Chronic Liver Disease Questionnaire (CLDQ), and so on. The research results of home and abroad showed that the quality of life of NAFLD patients is significantly lower than that of healthy people, and with the aggravation of the disease, the quality of life of such patients decreases, and may even be lower than other patients with chronic liver disease, and the reason for this may be related to factors such as body mass index (BMI) and complications. In clinical practice, the assessment of quality of life can fully reflect the health status of NAFLD patients, thereby helping to establish the personalized treatment goals to comprehensively assess the impact of disease on patients with clinical interventions.

Clinical and demographic patient characteristics, alcohol treatment goal preference and goal attainment during computer-assisted therapy with Breaking Free Online

ABSTRACTBackground: Few alcohol misuse interventions can be tailored to the individual and allow individuals to set personalized treatment goals, including reduction/moderation or abstinence. This study examined outcomes from a tailorable computer-assisted therapy program, Breaking Free Online (BFO), which prompts users to set personalized goals. Methods: Participants completed baseline and post-treatment assessments of alcohol dependence and use and biopsychosocial functioning. Whether baseline clinical and demographic participant characteristics predicted preferred treatment goal, and whether these characteristics and preferred treatment goal then predicted treatment goal attainment, were examined. Results: Participants who prioritized abstinence were more likely to be abstinent at baseline and to have received previous treatment, than participants who prioritized reduction/moderation. Participants who preferred reduction/moderation demonstrated better biopsychosocial functioning and lower alcohol dependence at baseline than those who preferred abstinence. Lower biopsychosocial impairment, lower alcohol dependence, and lower alcohol consumption were associated with a higher likelihood of achieving treatment goals, as was having abstinence as a goal. There were significant interactions between baseline alcohol consumption/severity of alcohol dependence and treatment goal preference. Conclusions: Findings may inform guidance around recommended treatment goals for individuals engaging with treatment for alcohol misuse.