Principal Investigator: Dr Matthew Maddocks

Lead institution: King’s College London

Award amount: £134,793

Dr Matthew Maddocks, Dr Stephen Ashford and Dr Lucy Fettes

Improving rehabilitation in palliative care using goal attainment scaling

Hospices are now starting to provide rehabilitation services, such as exercise classes, but there is little evidence to help us understand what treatments work best in which situations.

This grant, awarded in 2015, sought to improve palliative rehabilitation services by aligning care to the needs and rehabilitation goals of patients. After an initial assessment, hospice staff and participants agreed goals together using goal attainment scaling (GAS).

The objectives of the project were:

  • To identify common palliative rehabilitation goals.
  • To compare GAS to standardised global outcome measures.
  • To identify overall achievement of goals and examine the relationship between the goal set and different patient or intervention characteristics.
  • To examine the feasibility of using GAS as an intervention in future evaluation trials.

Goals did not have to be therapy driven, but could be goals that were important to the patient and appropriate, such as ‘I want to be able to make a drink for myself.’ This approach was very much about setting a person-centred goal. Goals had to be SMART (specific, measurable, achievable, realistic and timed).

Dr Maddocks and his team successfully recruited 364 patients across 10 UK hospice rehabilitation sites (4 of which were in London and six sites outside of London). In total, they set 645 individual goals, ranging from 1-4 goals per patient. Goals frequently related to mobility, general tasks and demands, community, social and civic life, mental functions and self-care. 310 (48.1%) goals were attained following rehabilitation interventions.

Individual factors positively associated with goal attainment were inpatient setting, short goal timeframe, minor difficulty level perceived by staff, living alone and interventions around mobility, task practice and equipment provision or training. Factors negatively associated with goal attainment included outpatient setting, longer goal timeframe, severe difficulty level perceived by staff and wheelchair or bed-bound patients.

This study demonstrates that patients with advanced progressive disease, receiving hospice care, can set and attain functional goals including near the end of life. Most goals focussed on retaining independence in everyday activities and situations, often by managing symptoms and emotions. It was evident that goal attainment in this setting was supported by setting shorter term and realistic goals.

Since the conclusion of the grant, most hospice therapy teams recruited to the project have continued to complete goal setting for all patients within their care. This shows the acceptability and recognised value of goal setting for those receiving palliative care.

The Trust is delighted to learn that the study is an exemplar for the new NIHR & Charities Consortium for Hospice and Community Research, which aims to make the UK a global leader in the area of hospice and community research within 5 years.

Co-applicants were: Professor Irene Higginson, Professor Lynne Turner-Stokes, Professor Richard Siegert, Dr Stephen Ashford, Professor Richard Harding, Dr Wei Gao and Professor Fliss Murtagh. Dr Lucy Fettes was the Research Assistant on the project.