Payne Christopher, Allee Tina
Female Neurourology, Stanford School of Medicine, Stanford, CA 94305-5118, USA.
Neurourol Urodyn. 2009;28(1):13-7. doi: 10.1002/nau.20616.
Goal Assessment Scaling (GAS), wherein patients specify goals then evaluate treatments with regard to goal achievement, has proven utility in assessing treatment of complex conditions such as chronic pain, rheumatoid arthritis, and incontinence. We used surveys and focus groups to characterize the goals of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) in order to create a pilot GAS.
37 patients with IC/PBS recorded and ranked their treatment goals which were pooled and analyzed for emergent domains and priority rankings. 15 patients participated in 3 separate focus groups. Focus group audiotapes were transcribed and reviewed to identify major themes and goals domains.
140 separate goals were collected. Mean number of goals 4+/-2.73% had pain goals and 56% had frequency and/or nocturia goals. Focus groups revealed that urgency is a separate entity from pain or frequency and any of these may take priority. The groups defined urgency for IC/PBS patient as "the need to urinate due to an unpleasant sensation that prevents attention to any other task." Additional goal domains of control, predictability, and information were explored. Unsatisfactory aspects of common urological surveys were discussed as well as positive and negative aspects of GAS.
Patients have individualized treatment goals. GAS holds promise for addressing individuality in a standardized format. A new instrument developed from this work is being piloted in a multicenter RCT. We also suggest that questionnaires investigating urgency in IC/PBS clarify the definition in a way more applicable to the specific condition.
目标评估量表（GAS），即患者明确目标，然后根据目标达成情况评估治疗效果，已被证明在评估慢性疼痛、类风湿性关节炎和尿失禁等复杂病症的治疗中具有实用价值。我们通过调查和焦点小组来描述间质性膀胱炎/膀胱疼痛综合征（IC/PBS）患者的目标，以创建一个试验性的GAS。
37例IC/PBS患者记录并排列他们的治疗目标，将这些目标汇总并分析，以确定出现的领域和优先排序。15名患者参加了3个单独的焦点小组。对焦点小组的录音进行转录和审查，以确定主要主题和目标领域。
共收集到140个不同的目标。平均目标数量为4±2.73%有疼痛目标，56%有尿频和/或夜尿目标。焦点小组表明，尿急是与疼痛或尿频不同的一个方面，这些方面中的任何一个都可能优先考虑。小组将IC/PBS患者的尿急定义为“由于一种令人不适的感觉而需要排尿，这种感觉会妨碍对任何其他任务的关注”。还探讨了控制、可预测性和信息等其他目标领域。讨论了常见泌尿外科检查中不尽人意的方面以及GAS的积极和消极方面。
患者有个性化的治疗目标。GAS有望以标准化的形式解决个体差异问题。基于这项工作开发的一种新工具正在一项多中心随机对照试验中进行试点。我们还建议，调查IC/PBS尿急情况的问卷应以更适用于该特定病症的方式明确其定义。
