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

Abstract

Background/aims  Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention (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 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. 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 Normalization Process Theory (NPT) were used to analyse and interpret data.  Results  Ten practices participated (5 in each arm) exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At six months post-intervention, the difference in mean asthma-related quality-of-life (mini-AQLQ) 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 six 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 £22.17.  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 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.  The trial was registered on the ISRCTN register (ISRCTN 18912042) on 26th June 2012.