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Patient Participation in Medical and Social Decisions in A lzheimer's Disease
Author(s) -
Hamann Johannes,
Bronner Katharina,
Margull Julia,
Mendel Rosmarie,
DiehlSchmid Janine,
Bühner Markus,
Klein Reinhold,
Schneider Antonius,
Kurz Alexander,
Perneczky Robert
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03661.x
Subject(s) - medicine , psychological intervention , competence (human resources) , dementia , disease , preference , patient participation , cognition , health care , gerontology , family medicine , psychiatry , psychology , social psychology , pathology , economics , microeconomics , economic growth
Objectives To analyze the preferences of people with amnestic mild cognitive impairment ( aMCI ) and mild dementia in A lzheimer's disease ( AD ) regarding different aspects of healthcare‐related decisions, to correlate these findings with different measures of decision‐making capacity, and to explore the views of relatives and referring physicians. Design Cross‐sectional survey. Setting University‐based memory clinic in M unich, G ermany. Participants One hundred people with aMCI or mild AD , their relatives (N = 99), and their referring physicians (N = 93). Measurements Participation preferences and decisional capacity and assessment of these measures according to relatives and physicians. Results Patients had a preference for participation in healthcare‐related decisions, especially in social ones. Overall, individuals wanted their relatives to play a secondary role in decision‐making. Relatives and referring physicians performed poorly in predicting the individuals’ participation preferences, and relatives wanted to attribute less decision‐making power to patients than the patients did themselves. Patients refrained from participation if they had lower Mini‐Mental State Examination scores or were unsure about their decisional capacity. There were deficits in decision‐making capacity, which mostly related to understanding of the information presented. There was only weak correlation between the different measures (patient's, relative's, and physician's estimate, M ac A rthur Competence Assessment Tool for Treatment) of the patients’ decisional capacity. Conclusion The combination of marked participation preferences and impairments in the decisional capacity of individuals with aMCI and early AD constitute an ethical and practical challenge. A thorough implementation of structured probes of the patients’ decisional capacity combined with interventions that aid patients in their decision‐making capability might help to overcome some of these challenges.