Pigott, Jennifer;
Armstrong, Megan;
Chesterman, Elizabeth;
Read, Joy;
Nimmons, Danielle;
Walters, Kate;
Davies, Nathan;
(2022)
Remote Consultations for People with Parkinson’s and Cognitive Impairment – A Qualitative Study with Patients, Caregivers and Healthcare Professionals.
JMIR Neurotechnology
(In press).
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Abstract
Background: The Covid-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognised as a potential barrier to remote healthcare interactions and is common and heterogeneous in Parkinson’s. Research studies have shown remote consultations in Parkinson’s to be feasible, but little is known about real life experience, especially for those with cognitive impairment. We explored the experiences and perceptions of remote consultations for people with Parkinson’s and cognitive impairment. Objective: To explore the experiences of remote consultations for People with Parkinson’s and Cognitive Impairments, from the perspective of service users and professionals, and investigate considerations for future service delivery. Method: Semi-structured interviews were conducted remotely with 11 people with Parkinson’s and cognitive impairment, 10 family caregivers and 24 Healthcare Professionals in 2020-2021. Purposive sampling was used. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results: Four themes were identified: The Nature of Remote Interactions; Challenges Exacerbated by Being Remote; Expectation versus Reality; and Optimising for the Future. Remote consultations were considered to be ‘transactional’ and less personal, with difficulties building rapport, and different in role to in-person consultations. The loss of non-verbal communication and ability of Healthcare Professionals to ‘sense’ led to remote consultations being perceived as riskier by all groups. Issues arising from communication and cognitive impairment, balancing of the person with Parkinson’s and caregiver voice, and discussions of the future, affect this population specifically. Remote consultations were reported to have been more successful than anticipated in all three groups. Obstacles were not always as expected, for example age was less of a barrier than predicted. Video consultations were perceived as being preferable to telephone consultations by most participants, but not accessible to all people with Parkinson’s. With widespread expectation of ongoing remote consultations, potential improvements for these three groups and healthcare services were identified, including practice, preparation, increased awareness of issues, expectation management by Healthcare Professionals, and more time and flexibility for consultations. Conclusion: Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services.
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