B LOGAN1, A K VIECELLI2,3, D W JOHNSON2,3,4, A TONG5, T COMANS1, M JANDA1, C POND6, E PASCOE1, N M PEEL1, L GRAY1, J POLE1, K POLKINGHORNE7, M JOSE8, E H GORDON1, N SCHOLES-ROBERTSON5, J BAILEY, L ROBISON2, C HAWLEY2,3, J VARGHESE2, C KIRIWANDENIYA2, D REIDLINGER2, R E HUBBARD1
1Centre for Health Services Research, University of Queensland, Brisbane, Australia, 2Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia, 3Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, 4Translational Research Institute, Brisbane, Australia, 5University of Sydney, Sydney, Australia, 6University of Newcastle, Newcastle, Australia, 7Monash Health, Melbourne, Australia, 8Royal Hobart Hospital, Hobart, Australia
Aim: To determine if a Comprehensive Geriatric Assessment (CGA) will allow frail older patients with chronic kidney disease (CKD) to better attain their treatment goals and improve their frailty and quality of life, while being cost-effective.
Background: There is an increasing number of frail older patients with CKD. Many of them face deteriorating health and functional status, which adversely affects their quality of life. CGA is an effective intervention to improve survival and independence of older people but its effect in people with CKD remains unknown.
Methods: GOAL is a NHMRC-funded cluster randomised controlled trial developed by consumers, clinicians and researchers. It will recruit patients from January 2021 aged ≥65 with CKD stage 3–5/5D and a Frailty Index >0.25. The intervention clusters will receive a CGA by a geriatrician to identify medical, social and functional needs, optimise medication prescribing and arrange multidisciplinary referral if required. The primary outcome is attainment of patient determined goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS scores at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost effectiveness and safety (cause-specific hospitalisations, mortality) at 12 months.
Results: A two-arm design of 16 clusters with 1:1 allocation (~500 participants) has 90% power to detect a clinically meaningful mean difference in GAS score of 10 units.
Conclusions: The GOAL trial addresses patient-prioritised outcomes and will be conducted, disseminated and implemented in partnership with patients and their caregivers. This is the first study, internationally, to evaluate the clinical and cost effectiveness of CGA in improving patient-important health outcomes in frail older people with CKD.
Benignus is an Advanced Trainee in Geriatric and General Medicine at Queensland Health. He is currently undertaking a PhD at the University of Queensland, focusing on frailty and goals of care in patients with moderate to severe chronic kidney disease.