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

Dooley, J; Bass, N; Livingston, G; McCabe, R; (2018) Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription. The British Journal of Psychiatry , 214 (4) pp. 213-217. 10.1192/bjp.2018.201. Green open access

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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. DECLARATIONS OF INTEREST: None.

Type: Article
Title: Involving patients with dementia in decisions to initiate treatment: effect on patient acceptance, satisfaction and medication prescription
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1192/bjp.2018.201
Publisher version: https://doi.org/10.1192/bjp.2018.201
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Dementia, Alzheimer's disease, medication decision, shared decision-making, communication
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10058264
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