Barriers and enablers to cognitive assessment in Parkinson's disease: A qualitative contextual inquiry

BackgroundCognitive impairment in Parkinson's disease (PD) is often overlooked, despite increased risk of dementia in PD. 'PDCogniCare' is an innovation aiming to improve access to cognitive assessments, for earlier diagnosis and care. This study explored barriers and enablers to cognitive assessment in PD, to inform implementation of 'PDCogniCare'.MethodsParticipants included ten people with PD, one caregiver, and nineteen health professionals within two Australian public health services. Semi-structured interviews were informed by the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Deductive and inductive analysis was utilised. Barriers were mapped to the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool to develop implementation strategies.ResultsSeven themes were identified: 1) lack of discussion about cognitive impairment limits access to cognitive assessments and interventions; 2) clinicians need to 'be on board with cognition'; 3) availability of clinic resources impacts delivery of cognitive screens and assessments; 4) variability of clinician decision-making processes to screen or refer patients for neuropsychological assessment; 5) impact of undergoing neuropsychological assessments on people living with PD; 6) uncertainty over benefits of cognitive assessment in changing clinical management; and 7) perceived advantages of 'PDCogniCare' over current practice. Strategies to address identified barriers included: clinician education and training, additional resource allocation, support and feedback, and involving patient/consumer advocates.ConclusionsSeveral barriers and enablers to cognitive assessment in PD were identified, relating to health professional knowledge, beliefs, context and resources. Strategies that address these may improve clinical practice for more proactive treatment and care.