This Kidney International commentary discusses the GOAL trial. Comprehensive geriatric assessment (CGA), a multidimensional assessment leading to a personalised care plan, is an established intervention for older people living with frailty. In GOAL, CGA delivered through a single outpatient geriatrician appointment did not improve goal attainment for older people with chronic kidney disease and frailty.
The author's reading is that this does not mean person-centred care is unhelpful. Other models of CGA and of person-centred care need to be evaluated, and embracing person-centred care should be a goal for every nephrology service. The commentary abstract does not give the trial's numbers, so the size of the null result and the population details are in the trial paper.
For clinicians, the practical point is about delivery. A single referral, however good the geriatric assessment, may not be enough to change what matters to a frail older patient with CKD. Conversations about goals, treatment burden and conservative kidney management probably need to be repeated and integrated into routine nephrology visits.
- Do not rely on a single geriatrician referral to meet the needs of a frail older patient with CKD.
- Ask older patients with CKD what matters most to them, and document the goals.
- Revisit goals at follow-up visits, not once.
- Consider conservative kidney management as an option to discuss when frailty is significant.
Why it matters
It challenges the idea that one referral is enough to deliver person-centred care for frail people with CKD.
Don't overread it
This is a commentary on a trial, the abstract gives no numbers, and it concerns one model of assessment delivered once.
The statistics, in plain English
A trial that finds no difference in goal attainment tells you that this particular delivery model did not work, not that the aim is wrong. Without the numbers, the size and precision of the null result are unknown.
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