Table 3 Themes from interviews with older adults and clinicians using goal attainment scaling

Theme

 Goal attainment scaling allows for shared decision making with older adults and clinicians

“When you’re so used to doing everything for yourself and you can’t do it anymore, so anyway, I think I was pretty low, thinking I don’t want to live like this. And she kind of brought out the idea of well, you’ve got so many skills, you know, why don’t you – and you talked about that – why don’t you do that? And so I did, with her encouragement” – 82-year-old woman, Interview P25

“I think that’s almost humble in, like, do you really – it was humbling to me always how little I know…And I’m always surprised, and that’s a good thing. I mean, it was humbling that no one had ever asked this person what she had wanted. And it was humbling to be with [name], like, well, I want to do a slideshow. I would never, you know, thought someone would have that capacity. That was, you know, it always makes me, like, as a clinician, it makes me stop and pause, and those were always good things, where I could just stop and pause.” – Social worker, Interview C19

 Goal attainment scaling supports communication and care planning

“I think helpful because just the same thing, like having these conversations and…what comes out of the conversations is like ‘What do you need to make this happen, and how can we support you?’” – Social worker, Interview C3

 Goal attainment scaling adds accountability, which may motivate or demotivate patients

“I told her, ‘I don’t want to set a timeline, because I don’t know if I can really reach that.’” You know, I don’t want to put a time limit on myself because, like I said, I – some days, I’m just really, really depressed, and I’ve been so sick…And lately I’ve been in a lot of pain, I feel, and re-injured my back. And, like, now I’m not focusing on nothing but trying to get this pain under control. So I don’t set a time limit on myself.” – 67-year-old woman, Interview P1

“When they see that there is so much potential for improvement without having to take these big leaps, I think that’s a motivating thing for them, too.” – Registered nurse, Interview C12

 Goal attainment scaling can be confusing

“I would sit there and read it with them because some of them were kind of vague, you know…They were like – it was kind of like a tongue twister to them. They just didn’t understand, so I kind of like – that’s why I kind of read every one to them.” – Physician, Interview C18

 Goal attainment scaling includes scaling negative outcomes, which can be disconcerting for clinicians and patients

“Well, we didn’t so much talk about what would happen to me if I didn’t reach my goals, but she has faith in me. She knows that I push myself and she knows I’ll reach them. She doesn’t doubt me.” – 67-year-old woman, Interview P1

“They’d be like, ‘Why are you asking me if it’s – like I’m going to meet this goal. Like, I’m going to do it. So why are you asking what would be a little bit worse? There’s no little bit worse. Like, this is – I’m going to do it,’ you know? And they were getting really frustrated by the scaling process.” – Social worker, Interview C3

Facilitators and barriers

 A visual reminder

“With my age to a lot of times I will forget…but with her coming in with the sheet, and this is what we said we’re going to do the last time I came in. I’m like, “OK.” Well, that makes me want to say, “Well, OK. Well, let me write this down here.” Or, “Let me stick it on my calendar.”– 64-year-old man, Interview P15

 Developing rapport

Interviewer: Do you feel that she was comfortable talking with you about it?

68-year-older woman: Yes…Because she’s very easygoing, you know, to talk to and, you know…you can get along with her very well, you know, and she’ll communicate with you very easy. (Interview P3)

 Repeated use of the method

Interviewer: Were you comfortable were you using the Goal Attainment Scale with patients?

Nurse practitioner: Not comfortable at the beginning, but then the more you do it, very comfortable. (Interview C17)

 Previous training

“It’s work that we were already doing. So it wasn’t, like, for some revolutionary, brand new topic or idea.” – Registered nurse, Interview C5