Exploring the User Experience of CGA-Q

Comprehensive Geriatric Assessment (CGA) is a multi-disciplinary, multi-domain intervention that involves reviewing an older person's physical, psychological, social and environmental health and then implementing a plan in collaboration with the patient. Its purpose is to facilitate a holistic assessment of an older person that considers the multiple, and potentially overlapping, issues they may be experiencing.

Cochrane reviews have shown that when CGA is delivered in an inpatient setting it reduces the risk of an individual dying or moving into a care facility. It has also been shown, through randomised control trials, to improve outcomes in the perioperative, hospital-at-home, and oncology setting. As a result, it is considered the gold-standard for managing frailty in older adults.

Person-centred care describes care that is focused on the needs and expectations of an individual, rather than a single disease or process. It improves the individual's quality of life and their satisfaction with their care. Its impact on outcomes is such that the World Health Organisation has called for it to be a key priority in healthcare delivery. Person-centred care is heralded as the gold-standard method for delivering care.

Currently, research on person-centred care primarily focuses on how an individual can measure whether care is person-centred. Conversely, there is clinical equipoise in regards to how a clinician can be supported to deliver person-centred CGA. The CGA-Q is a tool that is currently being used as part of routine care in some outpatient CGA clinics in the NHS and it seeks to facilitate person-centred care. The CGA-questionnaire was adapted from the CGA-GOLD questionnaire, which is validated for use in the outpatient older person's oncology service. The CGA-GOLD questionnaire's purpose is to identify which older person needs to undergo a CGA. However, the CGA-questionnaire differs significantly from this as its purpose is not for a needs assessment but instead to facilitate person-centred care. To understand the acceptability and impact of the CGA-Q and how it integrates into an NHS service the investigators will conduct focus groups with stakeholders including patients, carers, and healthcare professionals. The aim is to understand the stakeholder experience of using the CGA-Q. The investigators will also seek to understand the experience of engaging with CGA and their opinions of person-centred care.

By understanding the experience of using the CGA-Q the investigators will be able to generate an evidence base to inform its future use and wider application in healthcare services.

Inclusion criteria

• Patient inclusion criteria:

• Age 65 years or older
• Attending an outpatient CGA appointment
• Completed a CGA-Q as part of standard care
• English speaking
• Have sufficient cognitive function to participate in a focus group
• Have capacity to consent to participating in the study

Informal carer inclusion criteria:

• Age 18 years or older
• An informal carer for a patient who is attending an outpatient CGA appointment
• An informal carer for a patient who has completed a CGA-Q as part of standard care
• Attending the outpatient appointment with the individual they care for
• The person they care for consents to their informal carers participation in the study
• English speaking
• Have sufficient cognitive function to participate in a focus group
• Have capacity to consent to participating in the study

Healthcare professional inclusion criteria:

• A registered healthcare professional
• Involved in the delivery of an outpatient CGA appointment
• Has been involved in the episode of care during which a patient and or their carer completed the CGA-Q

Exclusion criteria

• Patient exclusion criteria:

• Assessed by the clinical care team to be too clinically unstable to participate in the study
• Declines to participate
• Not able to attend the focus group on the pre-set date

Informal carer exclusion criteria:

• Age less than 18 years
• Cares for the patient as part of their employment
• Declines to participate
• Not able to attend the focus group on the pre-set date

Healthcare professional exclusion criteria:

• Not involved in the delivery of an outpatient CGA clinic
• Has not seen any patients who have completed the CGA-Q
• Declines to participate
• Not able to attend the focus group on the pre-set date