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

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Involving patients with dementia in decisions to initiate treatment : Effect on patient acceptance, satisfaction and medication prescription. / Dooley, Jemima; Bass, Nick; Livingston, Gill; McCabe, Rose.

In: British Journal of Psychiatry, Vol. 214, No. 4, 01.04.2019, p. 213-217.

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Dooley, Jemima ; Bass, Nick ; Livingston, Gill ; McCabe, Rose. / Involving patients with dementia in decisions to initiate treatment : Effect on patient acceptance, satisfaction and medication prescription. In: British Journal of Psychiatry. 2019 ; Vol. 214, No. 4. pp. 213-217.

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@article{da26354e56434816ae5fb7bb61bf1cc8,
title = "Involving patients with dementia in decisions to initiate treatment: Effect on patient acceptance, satisfaction and medication prescription",
abstract = "BackgroundShared 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.AimsWe aimed to explore medication decisions in dementia, using a standardised Treatment Recommendation Coding Scheme.MethodWe 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.ResultsDoctors 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.ConclusionsDoctors 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 interestNone.",
keywords = "Alzheimer's disease, communication, Dementia, medication decision, shared decision-making",
author = "Jemima Dooley and Nick Bass and Gill Livingston and Rose McCabe",
year = "2019",
month = "4",
day = "1",
doi = "10.1192/bjp.2018.201",
language = "English",
volume = "214",
pages = "213--217",
journal = "British Journal of Psychiatry",
issn = "0007-1250",
publisher = "Royal College of Psychiatrists",
number = "4",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Involving patients with dementia in decisions to initiate treatment

T2 - Effect on patient acceptance, satisfaction and medication prescription

AU - Dooley, Jemima

AU - Bass, Nick

AU - Livingston, Gill

AU - McCabe, Rose

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BackgroundShared 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.AimsWe aimed to explore medication decisions in dementia, using a standardised Treatment Recommendation Coding Scheme.MethodWe 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.ResultsDoctors 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.ConclusionsDoctors 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 interestNone.

AB - BackgroundShared 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.AimsWe aimed to explore medication decisions in dementia, using a standardised Treatment Recommendation Coding Scheme.MethodWe 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.ResultsDoctors 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.ConclusionsDoctors 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 interestNone.

KW - Alzheimer's disease

KW - communication

KW - Dementia

KW - medication decision

KW - shared decision-making

UR - http://www.scopus.com/inward/record.url?scp=85063284612&partnerID=8YFLogxK

U2 - 10.1192/bjp.2018.201

DO - 10.1192/bjp.2018.201

M3 - Article

C2 - 30269695

AN - SCOPUS:85063284612

VL - 214

SP - 213

EP - 217

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

IS - 4

ER -