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Involving patients with dementia in decisions to initiate treatment: Effect on patient acceptance, satisfaction and medication prescription

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)213-217
Number of pages5
JournalBritish Journal of Psychiatry
Volume214
Issue number4
Early online date1 Oct 2018
DOIs
DateAccepted/In press - 28 Aug 2018
DateE-pub ahead of print - 1 Oct 2018
DatePublished (current) - 1 Apr 2019

Abstract

Background
Shared decision-making is advocated but may be affected by cognitive impairment. Measures of shared decision-making provide global descriptions of communication without detailed analysis of the subtle ways in which doctors invite patient input.

Aims
We aimed to explore medication decisions in dementia, using a standardised Treatment Recommendation Coding Scheme.

Method
We analysed 71 video-recorded dementia diagnostic meetings from nine memory clinics. Recommendations were coded as pronouncements (‘I will start you on medication’), proposals (‘Shall we try medication?’), suggestions (‘Would you like to try medication?’), offers (‘I can prescribe medication’) or assertions (‘There is medication’). Patient responses were coded as acceptance (‘I'd like to have that’), active resistance (‘I'm not very keen’) and passive resistance (minimal or no response). Cognitive test scores, prescription rates and satisfaction were assessed and associations were explored.

Results
Doctors used suggestions in 42% of meetings, proposals in 25%, assertions in 13%, pronouncements in 11% and offers in 9%. Over 80% of patients did not indicate clear acceptance. Patients were most likely to actively resist after suggestions. There was no association between cognitive impairment and recommendation format. Patients were less satisfied with pronouncements. Patient preference did not influence whether medication was prescribed.

Conclusions
Doctors initially nominate people with dementia as the decision maker, and this is unaffected by cognitive impairment. Over 80% of patients resisted starting medication, mostly through passive resistance, the most common form of disagreement in communication. Medication still tended to be prescribed, indicating that factors other than patient preference affect prescription.

Declarations of interest
None.

    Research areas

  • Alzheimer's disease, communication, Dementia, medication decision, shared decision-making

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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Cambridge University Press at https://doi.org/10.1192/bjp.2018.201 . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 391 KB, PDF document

    Licence: Other

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