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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for
Jing Wang1, Emilie M Blair2, Jane Forman2,3,4
1College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
Background And Objectives:
Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships.
Research Design And Methods:
Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC.
Results:
We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations.
Discussion And Implications:
This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.
Insights
Physicians may undertreat older adults with mild cognitive impairment (MCI) for cardiovascular disease (CVD) due to biased assumptions. Improving communication and patient involvement is crucial for equitable care and well-being.
Area of Science:
- Gerontology
- Cardiology
- Health Services Research
Background:
- Mild cognitive impairment (MCI) affects a significant portion of older adults.
- Physicians may undertreat cardiovascular disease (CVD) in older adults with MCI, potentially due to assumptions about patient preferences.
- This disparity highlights a need to understand patient-physician communication dynamics in CVD care for this population.
Purpose of the Study:
- To explore the reasons behind the discrepancy in CVD treatment recommendations for older adults with and without MCI.
- To investigate physician assumptions regarding patient preferences and decision-making capacity in older adults with MCI.
- To identify strategies for enhancing patient-physician communication and relationships in CVD management.
Main Methods:
- A descriptive qualitative study involving 20 dyads of older adults (11 with MCI, 9 with normal cognition) and their care partners.
- Semi-structured interviews were conducted to gather perspectives on CVD treatment recommendations and physician assumptions.
- Participants reflected on perceived undertreatment and physician biases related to MCI.
Main Results:
- Participants reacted negatively to the notion of undertreatment for CVD in patients with MCI.
- Physician assumptions about treatment effectiveness, prognosis, patient value, and adherence were identified as reasons for potential undertreatment.
- Physicians may involve MCI patients less in decision-making due to assumptions about capacity and time constraints.
Conclusions:
- There is a critical need for person-centered communication and shared decision-making for older adults with MCI.
- Involving patients and care partners ensures treatment decisions align with individual preferences and values.
- Addressing these communication barriers can improve care quality and outcomes for older adults with MCI.
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