Clinician‐patient communication during the diagnostic workup: The ABIDE project

Abstract

Introduction We aimed to describe clinician-patient communication in the diagnostic process of memory clinics, specifically clinician behavior known to facilitate knowledgeable participation of patients during consultations. Methods In this multicenter, observational study, we audio-recorded routine diagnostic consultations of 41 clinicians and 136 patients/caregivers at eight memory clinics. Patients/caregivers completed surveys after each audiotaped consultation. We used a study-specific coding scheme to categorize communication behavior. Results Clinicians often provided information on (results of) diagnostic testing. They infrequently invited questions and/or checked understanding. Clinician behavior to involve patients in decision-making about diagnostic testing was limited. Of note, patients/caregivers rarely expressed their information or involvement preferences. Yet, approximately, one quarter of them would have liked to receive more information. Discussion Involving patients more explicitly by means of shared decision-making could benefit the quality of care provided in memory clinics because it enables clinicians to attune the diagnostic workup to the individual patient's needs.

Clinicians’ communication with patients receiving a MCI diagnosis: The ABIDE project

“…Note. Of the total sample of patients participating in the ABIDE observational study [12], 21 (15%) were diagnosed with mild cognitive impairment (MCI), based on their retrospectively obtained medical record data. Post-diagnostic testing audio recordings were available from 13/21 MCI patients, who were seen by ten clinicians in seven Dutch memory clinics.…”

“…This study was part of the Alzheimer's Biomarkers in Daily Practice (ABIDE) project [11]. ABIDE encompasses an observational study of audiotaped consultations during the routine diagnostic work-up at Dutch memory clinics [12]. Written informed consent was obtained from clinicians, patients and care partners.…”

“…Next, audiorecordings were made of the clinician-patient consultations when patients were seen as part of normal clinical care at the memory clinic. Since our aim was to observe and describe naturalistic clinician-patient communication during the routine diagnostic work up for dementia in a broad range of memory clinics, no efforts were made to intervene or standardize the diagnostic work up (for a detailed description see Visser et al, [12], and the results section for details on diagnostic tests that patients underwent). For the current study we selected fully audiorecorded post-diagnostic testing consultations with MCI patients (N = 13), as based on their retrospectively obtained medical records (see Fig 1).…”

Communicating uncertainties when disclosing diagnostic test results for (Alzheimer's) dementia in the memory clinic: The ABIDE project

“…ABIDE addresses the value and use of diagnostic tests for AD to daily practice in memory clinics, including communication about test results . ABIDE encompasses an observational study of clinical encounters at eight Dutch memory clinics . During the routine diagnostic work‐up for dementia at those clinics, we audiotaped clinician‐patient consultations, that is the clinical encounter(s) prior to and after diagnostic testing.…”

“…Patients' Mini‐Mental State Examination (MMSE) score was retrieved from their medical records (range 0‐30, with higher scores indicate better cognitive function). Patients were retrospectively categorized into four diagnostic categories based on data retrieved from their medical record (for more details, see): (a) Dementia, (b) MCI, (c) Cognitively normal or (d) Other/Unclear; that is, another neurological disease was diagnosed, or diagnosis was postponed or unclear.…”