Patient and companion shared decision making and satisfaction with decisions about medication at dementia diagnosis
McCabe, R; Pavlickova, H; Xanthopoulou, DP; et al.Bass, N; Livingston, G; Dooley, J
Date: 13 May 2019
Journal
Age and Ageing
Publisher
Oxford University Press (OUP) for British Geriatrics Society
Publisher DOI
Abstract
Background: There is little research on how people with dementia are involved in
treatment decisions at diagnosis.
Objective: To measure shared decision making when starting cholinesterase
inhibitors, investigate associations with contextual factors and explore satisfaction
and experience of the diagnostic meeting.
Setting: Nine ...
Background: There is little research on how people with dementia are involved in
treatment decisions at diagnosis.
Objective: To measure shared decision making when starting cholinesterase
inhibitors, investigate associations with contextual factors and explore satisfaction
and experience of the diagnostic meeting.
Setting: Nine UK memory clinics in two geographical locations.
Subjects: 74 people receiving dementia diagnoses (with 69 companions) and 21
doctors.
Methods: We video-recorded 74 memory clinic consultations and rated doctor shared
decision making behaviours using the Observing Patient Involvement in Decision
Making scale (OPTION-5 scale). Patients and companions rated their satisfaction and
experience. Mixed-effects regressions investigated involvement and (1) number
people present, meeting length, capacity, cognitive functioning, diagnosis; and (2)
patient/companion satisfaction and consultation experience.
Results: Mean consultation time was 26.7 minutes. Mean OPTION-5 score was
22.5/100 (Standard Deviation =17.3). Doctors involved patients in decisions more
often when patients had mixed dementia (β=10.13, 95% confidence interval 1.25 to
19.0, p=.025) and in shorter meetings (β= -0.51, 95% CI -0.87 to -0.15, p=.006).
Patient and companion satisfaction were high and not associated with whether
doctors invited patient involvement. Half of patients and one-third companions were
uncertain about the meeting outcome, experienced communication barriers and
negative emotions.
Conclusions: Consultations scored low on shared decision making, but were comparable to other settings and were not lower with more cognitively impaired patients.
Negative patient and companion experiences reflect the importance of supporting
health care providers to address patient and companion emotions and need for information.
Institute of Health Research
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