Difference between revisions of "Dooley-etal2019"

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|Title=Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription
 
|Title=Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription
 
|Tag(s)=EMCA; Dementia; In press; Alzheimer's; Shared decision-making; Decisions
 
|Tag(s)=EMCA; Dementia; In press; Alzheimer's; Shared decision-making; Decisions
|Key=Dooley-etal2018a
+
|Key=Dooley-etal2019
|Year=2018
+
|Year=2019
 
|Language=English
 
|Language=English
 
|Journal=The British Journal of Psychiatry
 
|Journal=The British Journal of Psychiatry
 +
|Volume=214
 +
|Number=4
 +
|Pages=213–217
 
|URL=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/involving-patients-with-dementia-in-decisions-to-initiate-treatment-effect-on-patient-acceptance-satisfaction-and-medication-prescription/204C462FCFA5D42A983A96F20A9D5AF9
 
|URL=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/involving-patients-with-dementia-in-decisions-to-initiate-treatment-effect-on-patient-acceptance-satisfaction-and-medication-prescription/204C462FCFA5D42A983A96F20A9D5AF9
 
|DOI=https://doi.org/10.1192/bjp.2018.201
 
|DOI=https://doi.org/10.1192/bjp.2018.201

Revision as of 18:36, 10 October 2019

Dooley-etal2019
BibType ARTICLE
Key Dooley-etal2019
Author(s) Jemima Dooley, Nick Bass, Gill Livingston, Rose McCabe
Title Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription
Editor(s)
Tag(s) EMCA, Dementia, In press, Alzheimer's, Shared decision-making, Decisions
Publisher
Year 2019
Language English
City
Month
Journal The British Journal of Psychiatry
Volume 214
Number 4
Pages 213–217
URL Link
DOI https://doi.org/10.1192/bjp.2018.201
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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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.

Notes