Impact of Patient Mild Cognitive Impairment on Physician Decision-Making for Treatment.
Impact of Patient Mild Cognitive Impairment on Physician Decision-Making for Treatment.
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患者轻度认知障碍对医生治疗决策的影响。
DOI：
10.3233/jad-200700
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Levine DA
中科院分区：
文献类型：
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作者：
Blair EM;Zahuranec DB;Langa KM;Forman J;Reale BK;Kollman C;Giordani B;Levine DA
患有轻度认知障碍（MCI）的老年患者应在有临床指征时接受循证治疗。然而，与认知正常的患者相比，MCI 患者接受循证治疗的可能性似乎较小。探讨患者 MCI 诊断对医生决策的影响。采用半结构化访谈对 18 名心脏病学、神经学和内科医师进行定性研究。我们试图了解患有 MCI 的患者是否以及如何影响医生对五类治疗或检查（手术、侵入性检查、非侵入性检查、康复和预防性药物）的决定。我们使用定性内容分析来确定统一和反复出现的主题。大多数医生参与者将 MCI 描述为影响他们对至少一种治疗或测试的建议。我们确定了影响 MCI 患者医生建议的两个主要主题： 医生认为 MCI 患者认知能力下降会影响治疗；医生认为 MCI 患者的健康状况和身体机能较差，这会影响治疗。这两个主题代表了医生的信念，即 MCI 患者独立决策能力受损、无法坚持治疗、无法沟通治疗偏好以及治疗风险和负担增加。患者的 MCI 诊断会影响医生的治疗决策。医生对 MCI 患者的一些假设没有证据支持。这种现象可能解释了为什么许多 MCI 患者比认知正常的患者接受的有效治疗或测试更少。需要采取干预措施来改善医生对 MCI 的理解并为 MCI 患者做出治疗决策。
Older patients with mild cognitive impairment (MCI) should receive evidence-based treatments when clinically indicated. However, patients with MCI appear less likely than cognitively normal patients to receive evidence-based treatments. To explore the influence of a patient’s MCI diagnosis on physician decision-making. Qualitative study of 18 physicians from cardiology, neurology, and internal medicine using semi-structured interviews. We sought to understand whether and how a patient’s having MCI has influenced physicians’ decisions about five categories of treatments or tests (surgery, invasive tests, non-invasive tests, rehabilitation, and preventive medication). We used qualitative content analysis to identify the unifying and recurrent themes. Most physician participants described MCI as influencing their recommendations for at least one treatment or test. We identified two major themes as factors that influenced physician recommendations in patients with MCI: Physicians assume that MCI patients’ decreased cognitive ability will impact treatment; and physicians assume that MCI patients have poor health status and physical functioning that will impact treatment. These two themes were representative of physician beliefs that MCI patients have impaired independent decision-making, inability to adhere to treatment, inability to communicate treatment preferences, and increased risk and burden from treatment. A patient’s MCI diagnosis influences physician decision-making for treatment. Some physician assumptions about patients with MCI were not evidence-based. This phenomenon potentially explains why many patients with MCI get fewer effective treatments or tests than cognitively normal patients. Interventions that improve how physicians understand MCI and make decisions for treatments in patients with MCI are needed.