Exploring the user experience of CGA-Q
Research type
Research Study
Full title
Exploring the experience of patients, carers, and healthcare clinicians of the CGA-Q, a tool to facilitate person-centred Comprehensive Geriatric Assessment (CGA)
IRAS ID
337803
Contact name
Rebekah Schiff
Contact email
Sponsor organisation
Guy's & St Thomas' NHS Foundation Trust
Duration of Study in the UK
0 years, 3 months, 0 days
Research summary
Research Summary:
Comprehensive Geriatric Assessment (CGA) is a multi-disciplinary, multi-domain intervention that involves reviewing an older person’s physical, psychological, functional, social and environmental health and then implementing a plan in collaboration with the patient and/or carer. Its purpose is to facilitate a holistic assessment of an older person that considers the multiple, and potentially overlapping, issues they may be experiencing. CGA is known to reduce the risk of someone dying or moving into a care facility.Person-centred care focuses on the needs and expectations of an individual, rather than a single disease or process. It improves the individual’s quality of life and satisfaction with their care. Its impact on outcomes is such that the World Health Organisation has called it a key priority in healthcare delivery.
Although comprehensive, the CGA is not necessarily person-centred. The CGA-questionnaire (CGA-Q) is a patient/carer administered questionnaire developed by a team of geriatricians, primary care physicians and public health professionals. It consists of 20 tick-box questions covering 7 domains within the CGA. Its purpose is to facilitate person-centred care by allowing the user of the questionnaire to identify which areas of their physical, psychological, functional, social and environmental health are of concern. The questionnaire is then given to the clinician conducting the CGA so they can concentrate on the topics that are important to the patient. The CGA-Q is currently part of routine care in some NHS outpatient geriatrics clinics.
The aim of this study is to explore the patient, carers, and healthcare professionals' experience of using the CGA-Q. The study will do this by inviting patients, informal carers and healthcare professionals to participate in focus groups. The results will help to inform how the CGA-Q may impact the wider delivery of CGA-Q.
Summary of results:
Lay summary of study results: In total there were 10 participants in the study: 3 patients, 3 informal carers and 4 healthcare professionals (HCPs). Several common concepts were identified from the discussion groups. These are discussed below.Perceptions of health:
Patients said that how they feel about their health can change the way they answer questions. Patients explained that their mood and feelings about their symptoms can vary from day to day, so their answers on the CGA-Q might be different depending on the day. They also said that trying to stay positive and hopeful can affect how they report their health.
Informal carers thought that if they weren’t helping with the CGA-Q, their loved one might just say “no” to all the questions as they perceive their health to be ok.
HCPs knew this could happen and kept it in mind when looking at the answers. Sometimes, even if a patient said they didn’t have a symptom, the HCP would still ask about it to be sure.How do individuals choose what information to share and with whom?
Patients and informal carers talked about who they felt comfortable opening up to and what affected their decision to share certain information. This showed that the relationships between patients, carers, nurses, and doctors can be complicated by multiple factors, especially when the questions are very personal. These same factors can also affect how people answer the CGA-Q.
One common concern was the fear of being a “burden” or taking up too much of the doctor or nurse’s time. Because of this, some patients said they might downplay their symptoms or leave things out, even if those things were bothering them. Family carers also noticed that a fear of hospitals, doctors, or receiving a difficult diagnosis sometimes stops their loved ones from saying what they’re really going through.
CGA-Q was recognised to address some of these factors. Because the questions were in a list format, patients and their family carers found it easier to point out more issues than they might have if they'd had to explain everything out loud. For some patients, this also helped reduce the feeling of being a burden, since they were simply responding to questions on the CGA-Q. Informal carers said the list made it easier to bring up difficult topics with the person they were caring for - conversations that might not have happened otherwise.Advanced care planning
Although the importance of the topic was recognised, in general, patients and informal carers found this question difficult and emotional. It was felt that they were being asked to predict the future. They discussed how the question appeared suddenly in the CGA-Q and they were not expecting to have to think about this topic during their appointment.
HCPs thought the question was useful and might mean they can talk about the topic when it might not have come up otherwise. However, they recognised that it might be a difficult question for patients and carers to talk about.Person-centred care:
Patients and carers said the CGA-Q helped them talk about their overall health and raise issues that others might not usually ask about.
The HCPs felt that their assessments were already person-centred and so the CGA-Q did not change that. But they did think that the CGA-Q signalled to the patients or carers that they would be talking about all their health problems rather than just one.Specific details about the CGA-Q:
Participants gave suggestions on how to make the CGA-Q better and pointed out what should stay the same. These included:
- Adding “occasionally” as an answer option
- Continuing to give the CGA-Q to people in the waiting room rather than posting it home to complete before the appointment
- Informal carers and HCPs suggested adding a question about loneliness. HCPs suggested adding a question about digital access.
Participants give descriptions of what the CGA-Q is useful for:
- Patients and informal carers thought the CGA-Q might mean people talk about topics that would not have come up otherwise.
- HCPs were less certain about the CGA-Q's usefulness because they are already trained to deliver a focused CGA. Instead, they suggested it could be used as a screening tool to decide who needs a full CGA. Or it could be used by staff who aren't trained in caring for older people to complete a CGA.The results have provided valuable insights into how people experience the CGA-Q and how patients, carers and HCPs interact with the questionnaire. These findings will guide us in improving the CGA-Q and its use in clinics. We plan to share the results at conferences and in publications so that other patients can benefit from what we've learned.
REC name
East of England - Essex Research Ethics Committee
REC reference
24/EE/0144
Date of REC Opinion
21 Aug 2024
REC opinion
Further Information Favourable Opinion