The importance of aligning treatment goals in asthma management
Published online: July 1, 2021
Goal-oriented healthcare is an approach to disease management that accounts for patients’ preferences and values. The Global Initiative for Asthma (GINA) management strategies recommend asking patients about their treatment goals as a central part of care. However, despite this recommendation there is little information and guidance available to clinicians on how to approach this.
In a recent article in The Journal of Allergy and Clinical Immunology: In Practice, Mulvey et al. identified the treatment goals of patients from 2 randomized controlled trials in asthma. Thematic analysis was used to describe and quantify goal categories. In addition, goal categories were compared with clinical characteristics, and goal achievement was aligned with objectively measured treatment adherence.
Three categories of goals were identified: (1) Disease-specific – wanting to reduce symptoms or medication and/or increase asthma control; (2) Knowledge – wanting to understand more about asthma and asthma management; (3) Function-related – wanting to be more capable of social and fitness activities and/or reduce emotional stress due to asthma. Function-related goals were previously undescribed in asthma but accounted for up to 48% of patients’ goals in these trials. Only 53% of goals aligned with clinicians’ treatment goals. Patient’ goals that did align with those of clinicians were more likely to be achieved, and these patients were also more likely to achieve asthma control. Interestingly, patients who achieved their goals were more likely to reduce the rate at which they took their asthma medication (treatment adherence). This may be due to the fact that they had already achieved their desired treatment outcome. Patient goals have the potential to be a useful tool to discuss and promote adherence to treatment, with a new goal being set when a previous goal has been achieved.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.