Goal Achievement Provides New Insights Into Interstitial Cystitis/Painful Bladder Syndrome Symptoms And Outcomes

Main Category: Urology / Nephrology
Article Date: 14 Apr 2009 - 1:00 PDT

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UroToday.com - When faced with disorders that present as symptoms rather than signs, the clinician is dependent on patient reports to guide diagnosis and treatment. In clinical trials, where standardization is critical, the variability of symptoms and reporting styles moves from an occasional annoyance to a major obstacle. Lack of sensitive and consistent metrics can cripple the ability to detect clinically relevant change and prevent formation of meaningful conclusions about treatment efficacy.

Drs. Christopher Payne and Tina Allee from Stanford, California, in an excellent publication, have thought out this problem and concluded that there is significant merit in goal assessment scaling (GAS). They note that patient reported outcome measures, while increasingly more common in clinical trials, have significant limitations. They may fail to address factors that are important to the individual sufferer while at the same time demanding focus on irrelevant symptoms.

Goal Attainment Scaling, where the patient and/or provider set goals and then judge progress on the basis of goal attainment, may provide an answer. GAS was introduced for evaluation of mental health programs almost 50 years ago. It has gained popularity in a vast array of medical settings including chronic pain, rheumatoid arthritis, cardiac and neurological rehabilitation, and management of geriatric care. The authors used group assessment surveys and focus group discussions with their patients. When presented with GAS as a treatment metric, patients responded favorably. Concerns centered on methods of goal collection, types of goals they would be expected to report, and the ways their goals would be quantified. The group objected to the listing of lifestyle goals before those dealing with cardinal symptoms because it was felt that improvement of the cardinal symptoms was the primary concern and the achievement of lifestyle goals were proxy measures.

Payne and Allee report some interesting findings. Goal domains for BPS/IC included pain, frequency and nocturia, life style, medication, general disease goals, education, urination mechanics, generalized somatic symptoms/fatigue, urge, incontinence, volume, and seemingly unrelated body symptoms. They found that over a third of the time, frequency is a higher priority goal than pain relief. A consensus definition of urgency emerged as "the need to use the restroom due to an unpleasant sensation that prevents attention to any other task". The authors conclude that GAS might be as valuable a tool in the clinic setting as in the setting of a clinical trial.

Payne C, Allee T
Neurourol Urodyn. 2008 Dec 16;28(1):13-17
Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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