Week 3- Limitations and challenges to Collaborative Goal Setting and the GAS method
Hi everyone! Welcome back to week 3 of my blog post!
Last week overview
Last week, I mentioned that I was going to meet with my advisor and distribute consent forms to the families, which went very well. I met 3 of my advisor’s OT clients from her current case load and observed some of their therapy sessions. My advisor shared some of the activities she plans for her clients during the sessions and how each one is helpful for their well-being. I also gave out the home program weekly checklists to the families where they will monitor their child’s consistency with the home program activity. Additionally, I distributed the GAS sheets for the families to mark their child’s current progress toward their specific goal. At the top of the sheet, there was the scale for parents to circle their rating, and at the bottom, there was the same scale but for the therapist to mark their rating to show different perspectives on the client’s progress. But ideally, the numbers should be the same in the end. Two of the participants identified a -2 on the Goal Attainment Scale, which is expected for the baseline, as these short-term goals are meant to focus on areas that still require further development and effort before reaching the desired outcomes. This rating matched with the therapist’s judgements. However, one of the participant’s family identified their child as a -2 while the therapist slightly disagreed and circled -1. So, this person is said to be improving and performing better on their goal. I will give the scale to the families again on week 5 (middle of study) and week 7 (end of study) to measure their progress.
Although the concepts of collaborative goal setting and goal attainment scaling and crucial elements of my project, there are some limitations or challenges to each as well.
Challenges to Collaborative Goal Setting
Though collaborative goal setting has shown to improve patient’s confidence, motivation, and satisfaction, it can be challenging. This approach is recommended in clinical guidelines, however, evidence suggests that patient participation in rehabilitation goal setting is not maximized, particularly within the hospital setting. There was a study conducted to investigate physiotherapists’ perceptions about their experiences of collaborative goal setting with patients in the sub-acute stages after stroke in hospitals. Nine physiotherapists of varying experience were selected for this study and semi-structured interviews were conducted and audio-recorded. Three main themes emerged from the data.
The first one was the individual patient journey where they come to terms with the stroke. The second is the individual physiotherapy journey where they set and adapt goals for their patients develops and improves over time.
The third is finding a balance between the patient-directed goal setting and therapist-directed goal setting. The physiotherapist needs to consider what the patient hopes to achieve and their personal goals, but they also should use their expertise to make recommendations without interfering. At the end, the physiotherapists perceived that collaborating with patients in goal setting was important but challenging. This is because the collaboration requires interactions with other professionals, patients and families were perceived as complex, difficult and requiring significant effort.
Limitations to Goal Attainment Scaling
Though Goal Attainment Scaling is a very useful measuring tool in therapy, there still are some potential limitations when using it in a study. The first is that there can be biases in goal scaling, which can sometimes affect its validity. For example, goals that are overly easy to attain can be used so that major progress is shown. There can also be bias in goal rating where people show children make improvements that are not in fact real. To combat this, collaborative goal setting helps since it ensures that the therapy goals are meaningful and are not too easy for the clients to achieve. It is also important to emphasize that honesty in recording results is essential for the success and accuracy of this study.
The second limitation is that training and standardized implementation procedures are required, which can be time-consuming when therapists are unfamiliar with the GAS method.
The third is that GAS can interfere with day-to-day practice because therapists should not modify a goal in the course of intervention. For my study, each client will have one goal that they are focusing on which will not be changed anytime throughout the project.
These are some of the limitations and challenges to collaborative goal setting and the GAS method. Thank you for reading!
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