Abstract
The use of individual goals in psychosocial interventions ensures that these interventions are aligned with patient’s values and address their vital needs. There is preliminary evidence from small-scale studies that people with early stage dementia (PwD) can identify personally-meaningful therapy goals. Here we present evidence of successful goal-setting in a large multicentre RCT of cognitive rehabilitation for PwD.
The Bangor Goal Setting Interview was used to elicit therapy goals related to everyday functioning for 473 people with early stage AD, vascular, or mixed dementia as part of the baseline assessment in the GREAT trial. Researchers and PwD worked together to identify up to three specific, measurable, achievable, personally relevant and time-bound therapy goals. Identified goals were analysed thematically to reveal common therapy needs.
Over 1500 therapy goals were identified by 473 PwD. Goals were driven by the motivation to reduce dependence, improve safety and increase engagement in pleasurable activities. They related to better management of everyday life through improving orientation, contributing to household chores, managing medication, and locating lost items. There was also an emphasis on increase activity levels, with goals around participation in meaningful activities, socialisation, remembering names, exercising, and using new technology.
The overwhelming majority of PwD in the GREAT trial were able to identify meaningful therapy objectives. These findings have implications for research, clinical practice, and policy. An understanding of the areas where PwD most want support can be used to develop genuinely person-centred care and provide targeted support where and when it is needed most.