Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure.

BACKGROUND: Goals generated by Goal Attainment Scaling (GAS) can be used as an outcome measure to promote person-centred research and care. There are no training packages which support its use outside of the rehabilitation discipline. This paper describes the development and evaluation of a training package to support the implementation of GAS as an outcome measure in healthcare research. The training package consisted of classroom teaching, a training manual for self-directed learning, one-on-one simulation and hot reviews. It was developed for the GOAL Trial, a randomised controlled trial assessing a Comprehensive Geriatric Assessment's effectiveness in enabling frail older people living with chronic kidney disease to attain their goals. Training participants were invited to complete pre- and post-training online evaluation surveys. RESULTS: Forty-two healthcare professionals attended an initial online classroom teaching, with 27 proceeding to administer GAS to GOAL Trial patients. Response rates for the online pre- and post-training surveys were 95% and 72%, respectively. Prior to training, only 15% of participants reported being able to appropriately scale and troubleshoot GAS goals. Post-training this was 92%. There was 100% participant satisfaction for the training manual, one-on-one simulation, and hot reviews. CONCLUSIONS: This training package helps ensure healthcare professionals administering GAS have adequate knowledge and skills. It has the potential for adoption as a guide to support the implementation of GAS by other researchers seeking to embrace persont-centred principles in their work.

How frail is frail in oncology studies? A scoping review.

AIMS: The frailty index (FI) is one way in which frailty can be quantified. While it is measured as a continuous variable, various cut-off points have been used to categorise older adults as frail or non-frail, and these have largely been validated in the acute care or community settings for older adults without cancer. This review aimed to explore which FI categories have been applied to older adults with cancer and to determine why these categories were selected by study authors. METHODS: This scoping review searched Medline, EMBASE, Cochrane, CINAHL, and Web of Science databases for studies which measured and categorised an FI in adults with cancer. Of the 1994 screened, 41 were eligible for inclusion. Data including oncological setting, FI categories, and the references or rationale for categorisation were extracted and analysed. RESULTS: The FI score used to categorise participants as frail ranged from 0.06 to 0.35, with 0.35 being the most frequently used, followed by 0.25 and 0.20. The rationale for FI categories was provided in most studies but was not always relevant. Three of the included studies using an FI > 0.35 to define frailty were frequently referenced as the rationale for subsequent studies, however, the original rationale for this categorisation was unclear. Few studies sought to determine or validate optimum FI categorises in this population. CONCLUSION: There is significant variability in how studies have categorised the FI in older adults with cancer. An FI ≥ 0.35 to categorise frailty was used most frequently, however an FI in this range has often represented at least moderate to severe frailty in other highly-cited studies. These findings contrast with a scoping review of highly-cited studies categorising FI in older adults without cancer, where an FI ≥ 0.25 was most common. Maintaining the FI as a continuous variable is likely to be beneficial until further validation studies determine optimum FI categories in this population. Differences in how the FI has been categorised, and indeed how older adults have been labelled as 'frail', limits our ability to synthesise results and to understand the impact of frailty in cancer care.

Frailty and solid-organ transplant candidates: a scoping review.

BACKGROUND: There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates. METHODS: A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria. RESULTS: We found that studies used a wide range of frailty tools (N = 22), including four 'established' frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population. CONCLUSION: Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.

Goal attainment scaling as an outcome measure for randomised controlled trials: a scoping review.

OBJECTIVES: (1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials. DESIGN: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach. DATA SOURCES: PubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022. ELIGIBILITY CRITERIA: English-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers completed data extraction. Data collected underwent descriptive statistics. RESULTS: Of 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30-96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%). CONCLUSIONS: GAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results. PROSPERO REGISTRATION NUMBER: CRD42021237541.

Characteristics of patients referred for assessment of decision-making capacity in the acute medical setting of an outer-metropolitan hospital-A retrospective case series.

OBJECTIVE: To identify characteristics of older people referred for assessment of decision-making capacity in the acute hospital setting. METHODS: A retrospective chart audit was undertaken for 98 consecutive medical inpatients referred for capacity assessments between February 2015 and August 2017 in an outer-metropolitan hospital. The data were analysed using descriptive and univariate analysis. RESULTS: In this case series, 56% of patients had a diagnosis of dementia. Social isolation was common; 70% were not presently married, and 63% had no community services. For 90% of patients, the referral was to determine the person's capacity to make their own accommodation decisions-usually to return home on discharge. Of those with impaired capacity, 54% were discharged to residential aged care, whilst most who retained capacity were discharged home (73%). Those with impaired capacity were more likely to have a diagnosis of dementia and a prolonged length of stay (both P < 0.001).

Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women.

Chlamydia trachomatis results in tubal factor infertility in some women. Diagnosis of this tubal infertility is difficult and typically involves laparoscopy or hysterosalpingography to detect the tubal blockages. Numerous serological tests have been developed; however, they are presently not used for diagnosis without subsequent surgical investigation during the infertility investigation. This study aimed to develop a highly specific serological assay for chlamydial tubal factor infertility in women that could be used to recommend direct progression to invitro fertilization (IVF) treatment for women who are positive. Women were recruited from a variety of settings including women seeking fertility treatment, sexual health and general practitioner (GP) consultations or antenatal care (n=259). The serological assay was developed using sera from a large group of women by using infertile microimmunofluorescence (MIF)-positive women with tubal damage as the positives compared to infertile or acute infection and/or fertile controls (negatives). The new multi-peptide ELISA was highly specific for the detection of tubal factor infertility (P=0.011) compared to another ELISA (P=0.022) and MIF (P=0.099). The sensitivity of the assay should be improved before clinical utility. Potentially, a two-step testing protocol could be used during the initial infertility investigation, where MIF followed by a highly specific ELISA could be used to recommend direct progression to IVF for women who are positive.