Investigation of Collaborative Goal Setting Practices in Hospital-Based Speech Language Pathologists Using the Electronic Goal Attainment Scaling (EGAS) App

Abstract

An extensive body of literature supports the clinical utility and feasibility of client-centric goal-setting techniques in neurorehabilitation. However, such techniques are seldom used and difficult to adopt in mainstream clinical practice. Two primary barriers that limit uptake and adoption of individualized goal-setting techniques into routine practice include: (1) lack of an operationalized framework susceptible to variations in the characteristics of the user and constraints of a medical setting and (2) limited knowledge on the part of clinicians and clients to confidently engage in goal-setting conversations. The eGAS app was designed to address the need for a semi-structured client-centric goal-setting framework for clinicians engaged in neurorehabilitation.

This study used a single-subject design to investigate the effects of using eGAS in an outpatient hospital setting on clinician behavior and client responsiveness. A nonconcurrent, multiple-baseline design was used across three clinicians to determine if use of eGAS would result in functional changes in collaborative interviewing behaviors, validity of generated goal scales, and reliability of the process. Results revealed that using eGAS had strong functional effects on collaborative interviewing behaviors and validity of goal scales, and a weak effect on reliability. Another noteworthy finding was that eGAS could be implemented with relatively high fidelity within the constraints of a clinical context despite variations in the characteristics of the end-user, i.e. clients and clinicians. I discuss support for ecological validity of eGAS in terms of implementation barriers and facilitators that affected outcomes, methodological limitations, and future steps to improve design validity and implementation integrity.