PMID- 27931242 OWN - NLM STAT- MEDLINE DCOM- 20180112 LR - 20231111 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 17 IP - 1 DP - 2016 Dec 8 TI - Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma. PG - 584 LID - 584 AB - BACKGROUND: Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review. METHODS: The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data. RESULTS: Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76-6.65) versus UC 6.1: SD 0.81 (CI 5.63-6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by pound22.17. Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma. CONCLUSIONS: The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial. TRIAL REGISTRATION: ISRCTN18912042 . Registered on 26 June 2012. FAU - Hoskins, Gaylor AU - Hoskins G AUID- ORCID: 0000-0002-8393-2342 AD - Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, Scotland, UK. gaylor.hoskins@stir.ac.uk. FAU - Williams, Brian AU - Williams B AD - School of Nursing, Midwifery and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, Scotland. FAU - Abhyankar, Purva AU - Abhyankar P AD - Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, FK9 4LA, Scotland, UK. FAU - Donnan, Peter AU - Donnan P AD - Tayside Clinical Trials Unit, Level 10 Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK. FAU - Duncan, Edward AU - Duncan E AD - Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, Scotland, UK. FAU - Pinnock, Hilary AU - Pinnock H AD - Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK. FAU - van der Pol, Marjon AU - van der Pol M AD - Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK. FAU - Rauchhaus, Petra AU - Rauchhaus P AD - Tayside Clinical Trials Unit, Level 10 Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK. FAU - Taylor, Anne AU - Taylor A AD - Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, FK9 4LA, Scotland, UK. FAU - Sheikh, Aziz AU - Sheikh A AD - Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK. LA - eng SI - ISRCTN/ISRCTN18912042 GR - CZH/4/697/CSO_/Chief Scientist Office/United Kingdom GR - HERU1/CSO_/Chief Scientist Office/United Kingdom GR - NMAHP1/CSO_/Chief Scientist Office/United Kingdom GR - NMAHP2/CSO_/Chief Scientist Office/United Kingdom PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20161208 PL - England TA - Trials JT - Trials JID - 101263253 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Asthma/diagnosis/*nursing/physiopathology/psychology MH - Attitude of Health Personnel MH - *Communication MH - Cost of Illness MH - Feasibility Studies MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - *Patient Care Planning MH - Patient Participation MH - *Physician-Nurse Relations MH - Pilot Projects MH - *Primary Care Nursing MH - *Primary Health Care MH - Qualitative Research MH - *Quality of Life MH - Scotland MH - *Self Care MH - Time Factors MH - Treatment Outcome MH - Young Adult PMC - PMC5146838 OTO - NOTNLM OT - Asthma OT - Complex interventions OT - Goal setting OT - Mixed methods OT - Pilot cluster RCT OT - Self-management EDAT- 2016/12/10 06:00 MHDA- 2018/01/13 06:00 PMCR- 2016/12/08 CRDT- 2016/12/10 06:00 PHST- 2015/12/08 00:00 [received] PHST- 2016/11/05 00:00 [accepted] PHST- 2016/12/10 06:00 [entrez] PHST- 2016/12/10 06:00 [pubmed] PHST- 2018/01/13 06:00 [medline] PHST- 2016/12/08 00:00 [pmc-release] AID - 10.1186/s13063-016-1684-7 [pii] AID - 1684 [pii] AID - 10.1186/s13063-016-1684-7 [doi] PST - epublish SO - Trials. 2016 Dec 8;17(1):584. doi: 10.1186/s13063-016-1684-7.