Factors in Patient-Clinician Interactions That Influence the Decision-Making Process of Older Patients with Dementia

The importance of promoting the autonomy of people with dementia has been globally emphasized. Several studies have investigated factors that impede and facilitate their decision-making. However, few studies have explored these factors in light of their decision-making process. Therefore, this study aimed to determine factors in patient-clinician interactions that influence patient autonomy and participation in decision-making among Japanese patients with dementia.

The authors adopted qualitative methods to understand the perceptions of health care professionals such as physicians, nurses, physical therapists, care managers, and social workers. Between January and March 2022, individual in-depth interviews were conducted online with 24 health care professionals with ample experience in primary palliative care for dementia. The topics were the support provided in patients' decision-making, the support provided to proxy decision-makers, and the efforts undertaken for building a relationship between patients and families or among multidisciplinary teams. All interviews were audio-recorded electronically and transcribed verbatim. These data were synthesized and analyzed using content analysis.

Four main themes were derived that captured the factors that influence the decision-making process of Japanese patients with dementia in patient-clinician interactions: rapport, decision-making capability, provision of explanation, and presentation of options. The findings highlighted the importance of building rapport with patients through communication in the early stages of dementia, improving patients' decision-making capability and protecting vulnerable patients who cannot make decisions independently, explaining each option's risks and benefits in a comprehensible manner, and presenting a wide range of options to patients in everyday decision-making.

Overall, the themes were in accordance with the process of informed consent. The findings also showed that clinicians must understand the barriers to obtaining informed consent that arise from patients' cognitive impairment, decline, and fluctuations, in addition to cultural factors.