Novel Web-Based Technology to Promote Goal-Setting in Complex Chronic Illness: Randomized Controlled Trial

Area of Science:

• Pediatric Healthcare
• Health Informatics
• Patient-Centered Care

Background:

• Shared goal-setting is crucial for improving care quality in children with medical complexity.
• Few studies have evaluated interventions to enhance goal-setting efficacy.
• Children with medical complexity often experience declining care quality between clinical visits.

Purpose of the Study:

• To evaluate a novel internet-based tool, GoalKeeper, designed to promote shared goal-setting in pediatric complex care.
• To assess the impact of GoalKeeper on the quality of goal-setting and overall care quality.

Main Methods:

• A randomized stepped-wedge trial comparing GoalKeeper (intervention) to usual care.
• Inclusion of 67 parent-child dyads across primary and subspecialty clinics.
• Utilized the Patient Assessment of Care for Chronic Illness Care goal-setting domain to measure outcomes at baseline and 1 month.

Main Results:

• The intervention group using GoalKeeper showed sustained quality of goal-setting at follow-up, unlike the control group.
• Care quality also remained stable in the intervention group, while declining in the control group.
• The GoalKeeper tool was successfully used by most parents during clinical encounters.

Conclusions:

• Family-centered goal-setting, facilitated by digital tools like GoalKeeper, can mitigate the decline in care quality for children with medical complexity.
• Digital tools show feasibility for improving family-provider communication regarding patient goals.
• GoalKeeper represents a promising intervention for enhancing shared decision-making in pediatric complex care.