Table 6 Reflections on the administration of GAS

Training & Consistency:

• Our team of interviewers found that the training provided to the data collection team at the start of the study was effective, and that the training guide provided was useful.

• Interviewers also commented on the importance of thorough training for multiple teams constructing GAS guides, as well as ongoing communication among them, to ensure that all team members are approaching their GAS guides and data collection consistently.

• Core team members facilitated regular communication between sites.

• The GAS guide verification processes adopted in Alberta and Ontario suggested good alignment between different goal-setters.

Mode of Data Collection:

• Video calls and/or in-person administration may have enhanced this process, particularly when discussing sensitive topics. Feelings and sensitivities of patients are often revealed through their body language and facial expressions, and this was harder to read and/or respond to over the telephone.

• Interviewers enjoyed the opportunity to re-connect with participants at two timepoints, and participants often recognized the team members’ voices and remembered the initial GAS guide conversation. In some instances, this led to feelings of rapport

Duration and Prefacing the Goals Discussion:

• Baseline interviews were an average of 19 min with the final third of this time specifically devoted to goal setting.

• It took a relatively small amount of time to have meaningful discussions with patients about their goals; however, some interviewers found it challenging to work with participants to identify goals. A common initial response was “I don’t have any goals.”

• It was helpful to preface the discussion of goals with a question about health experiences and problems, and giving examples of the types of goals they might have.

• Because the concept of “health care goals” was confusing to many participants, we often rephrased the question to “if there was something about your health or health habits that you could work on in the coming 6 months, what would it be?”.

• By asking about health and experiences first, participants were able to base some of their goals on the health care experiences and issues described in their answers to earlier questions.

• Thus, while relatively little time was usually required for the goal-setting discussion, this process benefited from the earlier discussion of health experiences.

Discussing Sensitive Topics.

• Patients seemed more comfortable discussing physical activity, blood pressure, and other measurements, but some seemed hesitant to discuss specifics related to mental health, weight goals and other more personal goals.

• In an attempt to decrease the invasiveness of such discussions, we pre-emptively stated reassurances that we did not require specifics that they weren’t willing to share (e.g. their weight, the names of medications that they are on, etc.). They could, alternatively, state something like “My goal is to lose 10 lbs” (rather than sharing their weight), or “I would like to reduce the number of prescriptions that I am taking” (without revealing which medications they were on).