Identifying best practices for disclosure of amyloid imaging results: A randomized controlled trial

Abstract

Introduction: Empirical studies on effective communication for amyloid disclosure in mild cognitive impairment (MCI) are lacking. We aimed to study the impact of six communication strategies. Method:We performed a randomized controlled trial with seven randomly assigned, video-vignette conditions: six emphasizing a communication strategy and one basic condition. All showed a scripted consultation of a neurologist disclosing positive amyloid positron emission tomography (PET) scan results to an MCI patient. Healthy individuals (N = 1017; mean age ± SD 64 ± 8, 808 (79%) female) were instructed to imagine themselves in the video, answered questionnaires assessing information recall, emotional state, and behavioral intentions, and evaluate the physician/information.Results: "Risk best practice" resulted in highest free recall compared to other strategies (P < .05), except "emotional support". Recall in "emotional support" was better compared to "basic-' and elaborate information"(P < .05). "Risk best practice" resulted in the highest uncertainty (P < .001). "Teach-back" and "emotional support" contributed to the highest evaluations (P -values < .01). Conclusion:Risk communication best practices, attending to emotions, and teach-back techniques enhance information recall of amyloid-PET results, and could contribute to positive care evaluations.

Analysis of Psychological Symptoms Following Disclosure of Amyloid–Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline

“…In addition, although the number of participants with SCD+ who were accompanied by a study partner was very small, we can speculate that these individuals were more sensitive to the disclosure of positive biomarker results or might have been more distressed by the worry of how this information may change their families’ and friends’ perceptions of them than participants with SCD+ without study partners. Concerning risk communication, a recent study found that the use of some communication strategies might maximize the information uptake in mild cognitive impairment patients, thus resulting in higher trust and satisfaction …”

“…Concerning risk communication, a recent study found that the use of some communication strategies might maximize the information uptake in mild cognitive impairment patients, thus resulting in higher trust and satisfaction. 35 Delivering bad news to cognitively unimpaired patients could be one of the most challenging tasks physicians have to face in their clinical practice. Therefore, it is crucial to highlight that disclosing a positive amyloid-PET result was not associated with a clinically relevant psychological change.…”

Rationale and design of the ABOARD project (A Personalized Medicine Approach for Alzheimer's Disease)

“…In a first attempt to empirically derive best practices for disclosure of a positive amyloid PET scan to patients with mild cognitive impairment, we conducted a large randomized controlled study using a video‐vignette design (task 4.3). The resulting paper showed that risk communication best practices, actively attending to emotions, and the teach‐back technique enhance information recall of amyloid PET results and/or could contribute to positive evaluations of the clinician and the provided care 25 …”

Biomarker disclosure protocols in prodromal Alzheimer's disease clinical trials

“…While various groups, including the Advisory Group on Risk Evidence Education in Dementia (AGREED), 29 have begun to develop approaches and share resources, a unified and funded effort will be important to fully realize this goal. Researchers may follow the example of prior work on the development of practice guidelines for genetic disclosure in clinical trials 30 as well as ongoing work in investigating and developing optimal communication strategies and personalized biomarker result tools 31–33 …”