Rebecca G. Rogers, MD
University of New Mexico Health Sciences Center
Albuquerque, New Mexico
Brubaker L, Khuller V, Piault E, et al. Goal attainment scaling in patients with lower urinary tract symptoms: development and pilot testing of the Self-Assessment Goal Achievement (SAGA) questionnaire. Int Urogynecol J. 2011;22:937-946.
Lower urinary tract symptoms (LUTS) are common and adversely affect the lives of women who suffer from them. While it is widely accepted that patient reported outcomes (PROs) for functional disorders such as LUTS are the mainstay for symptom evaluation and effect on quality of life, traditional PRO measures may not adequately capture an individual patient’s expectations and goal for treatment. Goal attainment scaling (GAS) is a method by which patients participate in goal setting, rank the importance of goals that are set, and can be used as an outcome measure for treatment effectiveness. Importantly, goal setting by patients allow providers to address unrealistic treatment expectations and potentially avoid interventions unlikely to help achieve individual patient goals, or allow for a dialogue between patient and provider to set more realistic goals. This is the initial report on the development and pilot testing of the Self-Assessment Goal Achievement questionnaire (SAGA).
Validation of a questionnaire includes establishment of its validity and reliability. The Food and Drug Administration and others have emphasized the importance of including the patient’s voice in the generation of PRO measures. To this end, the authors utilized qualitative data from a prior study in which women recorded goals prior to surgery to generate a list of commonly described goals for patients with lower urinary tract symptoms (LUTS). The authors sought to generate a list of commonly stated treatment goals since they had observed that women sometimes had difficulty in listing their own goals without guidance. The list of goals was then further refined with patient interviews among women with a variety of LUTS and the goals list refined using standard qualitative analysis. The goal list as well as a section of the questionnaire left for patients to list their own goals (open-ended) was then pilot tested in 104 women with overactive bladder (OAB).
- The revised SAGA had 7 suggested symptom-related goals: frequency (daytime and night time), sensation to use the bathroom, voiding, starting or maintaining a urine stream, urine leakage, and urgency; and 5 open-ended treatment goals for patients to spontaneously indicate any individual goal. Treatment goals were rated with a 5-point scale, from “not very important goal” (1) to “very important goal” (5)
- Results from pilot testing with the SAGA in patients with OAB indicated that treatment goals rated as “very important” were reducing urgency, incontinence, nocturia, and daytime frequency
- Self-reported goals (from the open-ended part of the questionnaire) identified as “very important” by patients were reduction of incontinence, nocturia, and frequency
- Goals of decreasing straining, slow stream and hesitancy were ranked as less important
- The SAGA questionnaire has face validity among women with LUTS and experts who treat them. Further validation is required to determine whether or not SAGA is a useful outcome measure in clinical trials.
- SAGA may provide a format for negotiation of treatment expectations between providers and patients so that realistic goals can be set and achieved
Patient reported outcome measures play a central role in the evaluation and treatment of functional disorders of the pelvic floor including LUTS. Traditional measures are designed to provide data regarding symptoms and their effect on quality of life across populations, and may not accurately reflect an individual’s treatment goals and expectations. Goal attainment scaling is a method by which providers may better understand an individual patient’s expectations for treatment and enable providers to both negotiate and tailor care. While the final validation of this measure will require further testing, its introduction into the urogynecologic literature is unique.