Goal attainment scaling in the heart failure and stroke resilience caregiver intervention pilot study

Caregivers often serve as proxies for patients or inform patient-caregiver dyadic findings in interventions. We conducted a randomized waitlist control pilot of a caregiver support program focused on caregivers (not dyads): Heart Failure and Stroke Resilience Intervention for Caregivers (HEROIC). Goal attainment scaling (GAS) was used to measure goal progress and achievement; this measure is person-centered but has not been used to test prior caregiving interventions.

HEROIC was tested in a pilot study. Participants were randomized to immediate intervention or waitlist control groups. GAS data was collected at baseline, 12 weeks, and 24 weeks and a final interview to assess feasibility and acceptability was conducted at 24 weeks. Raw GAS data was converted to t-scores. We compared goal achievement for the overall sample, by group assignment (immediate intervention vs. waitlist control), and by goal domain. Two questions in the final interview focused on acceptability and feasibility of GAS were summarized.

Fifty caregivers were consented, and 31 completed baseline data collection. Caregivers (n = 31) were on average 58 years old (SD: 11), 84% identified as female and 45% identified as Black. Twenty-six participants completed GAS at 12 weeks, and 19 participants completed GAS at 24 weeks. Twenty-one (80.8%) and 16 (84.2%) caregivers met or exceeded their goal at 12 weeks and 24 weeks respectively. For the immediate intervention group, the mean change in scores pre-post intervention was 19.1 (SD: 9.4), ranging from 0 to 30. For the waitlist control group, the mean change in scores pre-post intervention was 13.8 (SD: 10.6), ranging from 0 to 30. For the immediate intervention group during their maintenance period (12 to 24 weeks), the mean change in scores was 20.9 (SD: 11.4), ranging from 0 to 30. All 19 caregivers were interviewed at 24 weeks and reported that GAS was simple to complete and reported satisfaction with the activity.

For clinical trials, GAS may serve as a key outcome and provide rich effectiveness data. While GAS represents investment of time and resources, the approach is valuable. We recommend future research to inform streamlining GAS while maintaining its person-centeredness.

ClinicalTrials.gov, NCT03963583, Registered 24 May 2019, https://clinicaltrials.gov/study/NCT03963583?term=Heart%25;20Failure%25;20Resilience%25;20Intervention%25;20for%25;20Caregivers%25;20(HEROIC)%26;rank=1 .