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At least 163 records · Page 9Linked to original sources

PubMed1999

The relationship between the effect of setting a goal on standing broad jump performance and behaviour regulation ability in children with intellectual disability.

The objectives of the present study were to investigate the differences in standing broad jump performance between two task conditions (with and without goal) and to clarify the relation of verbal behaviour regulation to this difference in children with intellectual disability. The subjects were 30 children with intellectual disability with an average age of 16.2 years. In the without-goal condition, subjects were instructed to jump as far as possible. In the with-goal condition, on the other hand, subjects were given a goal set 20 cm away from the distance of the first trial in the without-goal condition and instructed to jump for the goal. Verbal behaviour regulation ability was measured by three tasks on Garfield's motor impersistence test keeping eyes closed, protruding tongue with eyes open and keeping mouth open. The mean performance of the with-goal condition was 108 cm, while that of the without-goal condition was 102 cm. The difference between these results was significant, thus indicating the effectiveness of setting a goal to improve jumping performance. Among three independent variables (chronological age, IQ and behaviour regulation score), only the behaviour regulation score was found to be significantly related to the condition difference. It was more effective to demonstrate the goal when the behaviour regulation abilities of the children were lower, but giving the children a goal was not effective for subjects with Down's syndrome. Children with Down's syndrome were considered to have a deficiency in the motor ability itself, not in the system for expressing the motor ability.

Adolescent↗

PubMed1998

A taxonomy for goal setting in the care of persons with dementia.

OBJECTIVE: Develop a taxonomy for understanding and classifying goals in the care of persons with dementia. DESIGN: Qualitative study using open-ended interviews with key informants and the constant comparative method of qualitative data analysis. SETTING: The geriatric assessment center at a large academic medical center in Connecticut. PARTICIPANTS: Key informant interviews with 36 subjects: consecutive patients receiving geriatric assessment at the center and their primary family caregivers, case managers, and physicians of patients. MEASUREMENTS AND MAIN RESULTS: Goals, or desired outcomes, for the patient's care as described by patients, primary family caregivers, case managers, and physicians were the main measurements. Participant interviews were conducted until the point of theoretical saturation, i.e., until further interviews no longer provided new concepts. All participants articulated at least one goal. Specific goals were characterized by a limited number of goal attributes resulting in a taxonomy, or consistent classification system, for reported goals. These attributes include domain (or content), specificity, time frame, and level of challenge. CONCLUSIONS: The findings suggested that patients, primary family caregivers, and clinicians can articulate goals of care and may bring differing perspectives to the goal-setting process. The research identified a taxonomy that may facilitate negotiation of goals by revealing important, and perhaps overlooked, aspects of goals and the goal-setting process.

Activities of Daily Living↗

PubMed2003

When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?

BACKGROUND: For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians. OBJECTIVE: To assess the extent to which patients with type 2 diabetes agree with their primary care providers (PCPs) on diabetes treatment goals and strategies, the factors that predict agreement, and whether greater agreement is associated with better patient self-management of diabetes. DESIGN: One hundred twenty-seven pairs of patients and their PCPs in two health systems were surveyed about their top 3 diabetes treatment goals (desired outcomes) and strategies to meet those goals. Using several measures to evaluate agreement, we explored whether patient characteristics, such as education and attitudes toward treatment, and patient-provider interaction styles, such as shared decision making, were associated with greater agreement on treatment goals and strategies. We then examined whether agreement was associated with higher patient assessments of their diabetes care self-efficacy and self-management. RESULTS: Overall, agreement on top treatment goals and strategies was low (all kappa were less than 0.40). In multivariable analyses, however, patients with more education, greater belief in the efficacy of their diabetes treatment, and who shared in treatment decision making with their providers were more likely to agree with their providers on treatment goals or strategies. Similarly, physician reports of having discussed more content areas of diabetes self-care were associated with greater agreement on treatment strategies. In turn, greater agreement on treatment goals and strategies was associated both with higher patient diabetes care self-efficacy and assessments of their diabetes self-management. CONCLUSION: Although patients and their PCPs in general had poor agreement on goals and strategies for managing diabetes, agreement was associated with higher patient self-efficacy and assessments of their diabetes self-management. This supports the hypothesis that enhancing patient-provider agreement on both overall treatment goals and specific strategies to meet these goals may lead to improved patient outcomes.

Adult↗

PubMed2004

Understanding the relationships between wellbeing, goal-setting and depression in children.

OBJECTIVES: This study investigates children's conceptions of happiness and wellbeing in relation to goal choice. It examines the prevalence and impact of Conditional goal setting (CGS) on levels of wellbeing and depression. Conditional goal setting describes commitment toward an important goal resulting from a conception that happiness is an end-point achieved through the attainment of this goal. Conditional goal setting has been identified as a significant factor in the development and maintenance of depression in adults. This study examines these same concepts among children. METHOD: Combined interpretative and quantitative methodology is used. Thirty-six children aged 10-12 years participated in six focus groups discussing their understandings of happiness, important goals and beliefs concerning CGS. Children each attended one of three primary schools in the Perth metropolitan district. They also completed CGS and depression questionnaires. RESULTS: Responses were categorized into a number of common themes. Response content and the number of responses in each theoretical area were identified and discussed. The majority of participants conceptualized happiness as a goal dependent upon something extrinsic to themselves (such as an achievement or event). Statistical analyses suggested a significant relationship between goal setting styles, conceptualizations of happiness and depression. Depressed children were more likely than non-depressed children to be conditional goal setters. CONCLUSIONS: Findings suggest that some children conceptualize happiness as an outcome that is dependent on their important achievements and acquisitions. This conceptualization is related to depression. Alternatively, non-depressed children tended to conceptualize happiness as a process independent of goal achievement or failure.

Child↗

PubMedDate not supplied

Goal attainment in a randomized controlled trial of rehabilitation after myocardial infarction.

PURPOSE: Goal setting is an established strategy in health behavior change programs although its usefulness remains uncertain. The authors investigate the validity of attainment of a patient-identified goal as an outcome measure in cardiac rehabilitation after myocardial infarction. METHODS: On entry into a randomized controlled trial of cardiac rehabilitation after an acute myocardial infarction, patients identified one activity that, if and when attained, would reflect their perception of a successful recovery. Patients reported whether they had attained their goal and the time of goal attainment. This was then related to trial outcomes that included generic and specific health-related quality of life and percent predicted exercise tolerance. RESULTS: Goals identified by 180 of the 201 (89.6%) patients, were attained by 51.5% at 8 weeks and by 86.5% at 12 months. At the end of the 8-week intervention, there was a substantial trend for fewer rehabilitation than usual care patients to have attained their identified goal (P < 0.06), although rehabilitation patients demonstrated greater improvement in specific health-related quality of life and exercise tolerance than usual care patients (P < 0.05). Among patients who identified a recreational physical activity goal (26.7%), significantly fewer (P < 0.007) rehabilitation than usual care patients had attained their goal at the end of the intervention with no differences in improvement in outcomes. CONCLUSIONS: Although improvement in outcomes was greater in rehabilitation patients than usual care patients at 8 weeks, goal attainment, particularly for the recreational physical activity goal, was greater among usual care patients. The validity of self-identified activity goal attainment as a measure of the efficacy of cardiac rehabilitation is unclear and might give misleading results.

Exercise Therapy↗

PubMed2006

Goal setting as an outcome measure: A systematic review.

BACKGROUND: Goal achievement has been considered to be an important measure of outcome by clinicians working with patients in physical and neurological rehabilitation settings. This systematic review was undertaken to examine the reliability, validity and sensitivity of goal setting and goal attainment scaling approaches when used with working age and older people. AIMS AND OBJECTIVES: To review the reliability, validity and sensitivity of both goal setting and goal attainment scaling when employed as an outcome measure within a physical and neurological working age and older person rehabilitation environment, by examining the research literature covering the 36 years since goal-setting theory was proposed. METHODS: Data sources included a computer-aided literature search of published studies examining the reliability, validity and sensitivity of goal setting/goal attainment scaling, with further references sourced from articles obtained through this process. MAIN FINDINGS: There is strong evidence for the reliability, validity and sensitivity of goal attainment scaling. Empirical support was found for the validity of goal setting but research demonstrating its reliability and sensitivity is limited. CONCLUSIONS: Goal attainment scaling appears to be a sound measure for use in physical rehabilitation settings with working age and older people. Further work needs to be carried out with goal setting to establish its reliability and sensitivity as a measurement tool.

Persons with Disabilities↗

PubMed2001

Multiple-goal pursuit and its relation to cognitive, self-regulatory, and motivational strategies.

BACKGROUND: The topic of academic goals has provided very important information about students' motivation. Traditional research has described several mutually exclusive goals that elicit different motivational patterns. Nevertheless, goal-orientation research has reported the possibility that more than one goal may operate simultaneously. AIM: The purpose of this study was to characterise multiple-goal groups of students, who use various types of cognitive, self-regulatory, and motivational strategies. SAMPLE: Participants were 595 Spanish-speaking university students at the University of A Coruña. METHOD: In order to examine the relationships between goal orientations and strategies, a Pearson correlational analysis was performed. Then, a cluster analysis was performed to identify potential subgroups of students with more than one simultaneously operative goal. Finally, a one-way test was conducted to determine whether the multiple-goal clusters differed in any of the nine strategies. RESULTS: Only those students who reported high task orientation tended to exhibit more frequent use of cognitive and self-regulatory strategies. Nevertheless, this does not mean that learning processes are only optimised by task orientation. When multiple-goal adoption was considered, students who developed the most positive self-regulation were characterised by their focus on learning, but also by their desire to avoid being judged negatively by others. CONCLUSIONS: Students should not adopt only task goals, which are sometimes overvalued, but also other kinds of goals that allow them to manage their learning and make it more flexible in each situation. This aspect characterises self-regulated learning, which is defined not only by cognitive and behavioural regulation but also by motivational regulation.

Adult↗

PubMed2002

Classroom goal structure and student disruptive behaviour.

BACKGROUND: Achievement goal theory suggests that the emphasis on mastery and performance goals in the classroom (the classroom goal structure) is related to students' patterns of learning and behaviour. This theory can offer a preventative holistic approach for dealing with students' disruptive behaviour. AIMS: The present study investigates whether the goal structure in the classroom is related to the incidence of disruptive behaviour. SAMPLE AND METHODS: A total of 388 ninth-grade students from 60 classrooms in five ethnically diverse high schools responded to surveys asking about the perceived goal structures, their personal achievement goals, and their involvement in disruptive behaviour in their maths classroom. Their maths teachers responded to surveys asking about their goal-related approaches to instruction. RESULTS: Using hierarchical linear modelling (HLM), at the student level, being male and having lower achievement was related to reports of disruptive behaviour. In addition, personal mastery goals were related to lower reports of disruptive behaviour and personal performance-approach and performance-avoidance goals were related to higher reports of disruptive behaviour. Disruptive behaviour also varied significantly between classrooms. Aggregated student perceptions of a mastery goal structure were related to a lower incidence, and aggregated student perceptions of a performance-approach goal structure were related to a higher incidence of disruptive behaviour. CONCLUSION: The implications of the findings to approaches for dealing with disruptive behaviour are discussed.

Adolescent↗

PubMed1999

A structural model of achievement motives, performance approach and avoidance goals, and performance among Norwegian olympic athletes.

A structural model of achievement motives, performance approach and avoidance goals, and performance was applied and tested among 136 Norwegian Olympic level athletes. Achievement motives, competitive behavior over time, performance approach goal-clarity, and performance-avoidance goals were assessed, and elite performance observed. Analysis indicated that the motive to achieve success is positively correlated with competitive behavior over time (a long-term goal), whereas the motive to avoid failure is positively associated with performance avoidance goals. Both long-term competitive behavior goals and performance approach goal-clarity were positively correlated with elite performance whereas the performance-avoidance goal was negatively correlated with performance. When the proximal influences of goals are controlled, the achievement motives are not significantly related to performance. In this structural model, motives and goals shared 32% of the variance with the performance measure, whereas a more complicated model including goals, sex, and a triple interaction of sex and motives shared 42% of the variance with the performance measure.

Achievement↗

PubMed2001

A model for achievement motives, goal orientations, intrinsic interest, and academic achievement.

This study investigated the effects of approach and avoidance achievement motives (the motive to achieve success and the motive to avoid failure) on three goal orientations (mastery, performance-approach, performance-avoidance goals) and the effects of goal orientations on intrinsic interest in learning and academic achievement for 157 tenth and 135 eleventh grade students of a Japanese girls' high school. Structural equation modeling indicated that mastery goals arose mainly from the motive to achieve success; however, the positive relation between the motive to avoid failure and mastery goals was also found. Performance-approach goals were related both the motive to achieve success and the motive to avoid failure. Performance-avoidance goals arouse mainly from the motive to avoid failure; however, the positive relation between the motive to achieve success and these goals was found. Mastery goals positively correlated with intrinsic interest and academic achievement, and scores on both performance-approach goals and performance-avoidance goals had no significant effects on either intrinsic or academic achievement.

Achievement↗

PubMedDate not supplied

Goal setting and health risk reduction.

The effectiveness of client participation in goal selection aimed at health risk reduction was compared with the effectiveness of provider-selected goals and of no goal setting. No difference in goal attainment was found between the two groups with goals. However, analyses of covariance for selected subsamples of individuals at risk revealed a significant difference between goal-setting groups for weight reduction, with the collaborative goal-setting group being more effective. Covariance analyses for other subsamples at risk showed significant differences between the goal-setting groups for current health age and potential for life expectancy increase; the provider goal-setting group proved to be more effective. Paired t tests within groups revealed that the provider goal-setting group made significant change in alcohol intake, seat belt use, and exercise as well as in global measures of current health age, estimated life expectancy, and potential for life expectancy increase. For the collaborative goal-setting group, significant change was found in weight reduction, exercise levels, and the global measures of estimated life expectancy and potential for life expectancy increase. The control group made a significant change in exercise, but not in any of the global measures of risk reduction.

Adult↗

PubMedDate not supplied

Setting goals and targets for performance standards within the Swedish health care system.

The development of any health care system towards setting goals and targets and intended outcomes--with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces--makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal-setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process. The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It 'stands and falls' with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed. This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a 'we-feeling' which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given. It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage achievement.

Attitude of Health Personnel↗

PubMed2000

Relation between Achievement Goals and Self-Beliefs of Middle School Students in Writing and Science.

Two studies were conducted to investigate the relationship between achievement goals (task, performance-approach, performance-avoid), motivation constructs, and gender in the areas of middle school writing (N = 497) and science (N = 281). In both studies, task goals were associated positively with self-efficacy, self-concept, and self-efficacy for self-regulation and negatively with apprehension; performance-approach goals were associated positively with self-concept; and performance-avoid goals were associated negatively with self-concept and self-efficacy for self-regulation and positively with apprehension. In writing, performance-approach goals also related positively with self-efficacy, whereas performance-avoid goals related negatively and girls had stronger task goals. Findings related to performance-approach goals suggest that a developmental component may be at work in determining whether these goals serve a facilitative function in fostering motivation. Task goals and performance-approach goals were related, suggesting that they are each grounded in self-regulatory practices that lead to positive outcomes. Copyright 2000 Academic Press.

Journal Article↗

PubMed2004

Individualised treatment goals in diabetes care.

OBJECTIVES: To examine 1) patients' characteristics according to the treatment goal chosen at diabetes diagnosis, and 2) the association between individualised goals for glycated haemoglobin (HbA1c), blood pressure (BP) and lipids, and the risk factor level subsequently achieved. DESIGN: Follow-up study embedded in a multifaceted intervention study directed at doctors encouraging individualised goal-setting in newly diagnosed diabetic patients aged > or = 40 years. SETTING: General practice. SUBJECTS: In all, 243 general practitioners and 674 patients participated. MAIN OUTCOME MEASURES: Risk factors for diabetic complications. RESULTS: Relatively young age, low diagnostic plasma glucose, low BMI, a moderate or high level of physical activity and normoalbuminuria were associated with a treatment goal of good control at diagnosis. After 5 years, median HbA1c was 8.2%, 8.6% and 8.0% in patients with a goal of good, acceptable and poor control, respectively. Patients with a goal of good control versus those with a goal of acceptable control had a lower HbA1c level in a regression analysis adjusted for age, sex, HbA1c at diagnosis, BMI, total cholesterol, fasting triglycerides, BP, physical activity, smoking status and diabetes duration. We found no association between goals and the level of BP and lipids. CONCLUSION: Doctors tend to pursue normoglycaemia in relatively young patients with low blood glucose, low BMI, high activity level and normoalbuminuria. Patients for whom a goal of normoglycaemia was chosen at diagnosis achieved favourable glycaemic control at 5-year follow-up. Whether doctors choosing the goals were good at predicting future glycaemic control, or whether goal-setting is an important motivational factor in achieving optimal glycaemic control needs to be explored.

Aged↗

PubMed1992

Compliance with dietary goals in a Queensland community.

Dietary goals designed to improve nutritional health and lower the risk of chronic disease have been drawn up in Australia. Compliance with quantified goals was assessed in a random sample of 91 residents of Nambour, a typical community in southeast Queensland. Compliance was highest for alcohol and cholesterol goals. About three-quarters of the sample complied with the goal of limiting alcohol intake to five per cent of energy intake, and over half complied with the goal to limit daily cholesterol intake to less than 300mg. Compliance was lower for total fat and fibre goals. About 40% of the sample complied with the goal of consuming less than 33% of energy as fat or the goal of consuming 30g or more fibre per day. Compliance was slightly better for women than for men. Only a small proportion of the sample complied with goals to increase total carbohydrate intake to 55% or more of energy, or to limit saturated fatty acid intake to 10% of energy. For each of the goals, some were far from complying. In general, compliance with goals was lowest for males under 40 and was also low for women under 40.

Adult↗

PubMed2004

Current lipid management and low cholesterol goal attainment in common daily practice in Spain. The REALITY Study.

OBJECTIVE: To evaluate prescribing patterns of lipid-lowering drugs used in management of patients at risk of coronary heart disease (CHD) in usual clinical practice in Spain and to assess low-density lipoprotein cholesterol (LDL-C) goal attainment among CHD and CHD equivalent patients (< 100 mg/dL) and non-CHD patients with two or more risk factors (< 130 mg/dL) who were prescribed lipid-lowering drugs. METHODS: Cohort study with retrospective chart review at 23 primary care centres and 16 lipid treatment centres across Spain (59% primary care; 41% outpatient lipid centres). Physicians consecutively identified eligible patients. Adults (aged > or = 18 years) with CHD/CHD equivalent or two or more major risk factors prior to first prescription of lipid-lowering drugs were eligible. Medical records were reviewed by physicians to collect patient characteristics, baseline and follow-up laboratory values and lipid-lowering drug treatment data. RESULTS: 619 patients (45.5% CHD and CHD equivalent patients and 54.5% non-CHD with two or more major risk factors) were included in the study with an average study follow-up of 3.6 years. Mean age was 60.1 years (SD 10.2), and 47.8% were female. Mean baseline LDL-C was 178 mg/dL (SD 45.0) for the CHD/CHD equivalent patients and 191 mg/dL (SD 56.95) for patients with two or more risk factors. Statins were the initial lipid-lowering drugs in 90.2% of patients; 52.5% of patients were initiated on low-dose (simvastatin 10mg or lower potency) statins. Overall 20.2% of CHD/CHD equivalent and 31.4% of patients with two or more risk factors attained LDL-C goal during the study period; of patients not attaining goal, 28.7% required an additional LDL-C reduction of > 30% to attain goal. In a logistic regression model for goal attainment, CHD/CHD equivalent patients (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.31, 0.72) and patients with baseline LDL-C > 190 mg/dL (OR 0.53; 95% CI 0.35, 0.80) were least likely to reach cholesterol goal when compared with patients having baseline LDL-C > 100 mg/dL and < 130 mg/dL. CONCLUSION: Only 12.9% of patients attained LDL-C goal on their initial lipid-lowering drugs, and an additional 13.4% achieved goal after a change in their lipid-lowering therapy, resulting in 73.7% of patients not attaining goal after at least 3 years of follow-up, after initiation of lipid-lowering therapy. Patients who would gain the most from aggressive lipid lowering (CHD patients and patients with high baseline LDL-C) were least likely to achieve goal. More effective lipid management is needed to help these patients lower their cholesterol to goal levels or even lower.

Cholesterol, HDL↗

PubMedDate not supplied

Attainment of goals from national guidelines among persons with type 2 diabetes: a cohort study in an academic family medicine setting.

BACKGROUND: Cardiovascular disease is the leading cause of mortality in patients with diabetes, but goals for reduction of modifable cardiovascular risk factors are difficult to achieve in primary care. We evaluated the change in risk factor control for a cohort of patients with diabetes and hyperlipidemia over a four-year period, as well as the change in proportion of patients meeting clinical practice guideline goals. METHODS: Medical records were reviewed from a cohort of 86 randomly selected persons with type 2 diabetes in an academic family medicine setting. Data were abstracted to assess the attainment of and change in five treatment goals related to glycemic, blood pressure, and lipid control from 1999-2003. Descriptive statistics were applied to demographic variables. Mean differences in outcomes were assessed with the paired t-test. The McNemar test was used to assess non-parametric variables, and the Wilcoxon signed ranks test was applied to differences achieved in mean goal scores for outcome variables. RESULT: The mean numbers of treatment goals attained were 2.76 (SD = 0.92) in 1999 and 2.48 (SD = 1.1) in 2003. Significant improvements were noted in the mean values of HbA1c (0.4% decrease, p = 0.03), diastolic blood pressure (4.3mmHg decrease, p < 0.001), low-density lipoprotein cholesterol (LDL-C; 10.6 mg/dL decrease, p < 0.01), and high-density lipoprotein cholesterol (HDL-C; 8.3 mg/dL increase, p < 0.001) over the four-year study interval. No significant differences were noted in the percent at goal during the study for HDL-C or for HbA1c. A significant decrease was found in the percent at goal from 1999-2003 for LDL-C from 79% to 40%, respectively). The decrease in the percent LDL-C at goal was explained by the more stringent practice guideline goals introduced in 2001 for diabetes (i.e., LDL-C < 100 mg/dL). CONCLUSION: Despite significant improvement in mean values of modifiable risk factors, the percent of patients meeting 2003 guideline goals for HbA1c, systolic blood pressure, and LDL cholesterol did not improve. These findings suggest that patient-level improvements may not be adequate indicators of a practices achievement of guideline recommendations. Percent attainment of guideline goals may be a useful peformance measure of practice-level quality improvement initiatives.

Blood Pressure↗

PubMed1997

Can goals of care be used to predict intervention preferences in an advance directive?

BACKGROUND: Some have suggested that advance directives elicit goals of care from patients, instead of or in addition to specific intervention preferences, but little is known about whether goals of care can be used in a meaningful way on documents or whether they can predict preferences for specific interventions. METHODS: Attending physicians (n = 716) at the Massachusetts General Hospital in Boston were surveyed to elicit general goals of care (eg, treat everything or comfort measures only) along with specific preferences for 11 medical, interventions in 6 scenarios. In each scenario, each goal was classified as an adequate predictor of acceptance or rejection of an intervention if its predictive value of the preference for that intervention was at least 80%. RESULTS: Goals varied with scenarios (P < .001) in a predictable manner. The goal treat everything was an adequate predictor of acceptance of each intervention, and comfort was an adequate predictor of rejection for nearly every intervention. Attempt cure adequately predicted acceptance of almost every nonaggressive intervention, but did not predict acceptance of aggressive interventions. Quality of life predicted rejection of aggressive interventions in 3 scenarios, but was not useful in other cases. When goals were predictors of preferences, the mean range of 95% confidence intervals for their predictive values was generally 20% or less. CONCLUSIONS: Goals have a valid role in advance directives, since the goal choices had a logical relationship to scenarios and intervention choices. However, the 2 goals attempt cure and choose quality of life were not predictive in many instances. If these findings hold true for more general populations of patients, then advance directive documents will need to rely on more than these general goal statements if they are to adequately represent patient preferences.

Acute Disease↗