McCue Maggie, Parikh Sagar V, Mucha Lisa, Sarkey Sara, Cao Charlie, Eramo Anna, Opler Mark, Webber-Lind Briana, François Clément
Takeda Pharmaceuticals U.S.A., Inc., Deerfield, IL, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, USA.
Neurol Ther. 2019 Dec;8(2):167-176. doi: 10.1007/s40120-019-00151-w. Epub 2019 Aug 21.
The need for patient-centered care has become a focal point of healthcare improvement initiatives. Shared decision making-in which patients and clinicians communicate about various treatment options and goals and patient input is considered when making treatment decisions-has been associated with improved health and quality of life. A method of treatment evaluation allowing incorporation of patient-specific goals and perspectives is of increasing interest to healthcare providers, payers, and patients. An approach that allows incorporation of shared goal setting is possible via use of an instrument called the Goal Attainment Scale (GAS). This scale provides the structure for measuring progress toward treatment goals set through patient-clinician collaboration. The goal attainment approach has been used as a primary outcomes measure in numerous studies but not in major depressive disorder (MDD). As MDD is a complex, multidimensional disorder affecting each patient differently, the use of GAS methodology is a relevant framework for setting personalized meaningful treatment goals. Initial research into the feasibility of using the GAS in MDD (GAS-D) to measure patient-centric outcomes that may be neglected when more traditional scales are used has been encouraging. The objective of this Commentary is to provide background and rationale for implementation of the GAS-D in clinical practice.Funding Takeda Pharmaceutical Company, Ltd., and Lundbeck LLC.
以患者为中心的护理需求已成为医疗保健改进举措的焦点。共同决策——即患者和临床医生就各种治疗选择和目标进行沟通,并在做出治疗决策时考虑患者的意见——已与健康状况和生活质量的改善相关联。一种允许纳入患者特定目标和观点的治疗评估方法越来越受到医疗服务提供者、支付方和患者的关注。通过使用一种名为目标达成量表(GAS)的工具,可以实现一种允许纳入共同目标设定的方法。该量表为衡量通过患者与临床医生合作设定的治疗目标的进展情况提供了框架。目标达成方法已在众多研究中用作主要结局指标,但在重度抑郁症(MDD)中尚未使用。由于MDD是一种复杂的多维度疾病,对每个患者的影响各不相同,因此使用GAS方法是设定个性化有意义治疗目标的相关框架。对在MDD中使用GAS(GAS-D)来衡量以患者为中心的结局(当使用更传统的量表时可能会被忽视)的可行性进行的初步研究令人鼓舞。本评论的目的是为在临床实践中实施GAS-D提供背景和理论依据。资助:武田制药有限公司和灵北有限责任公司。