Physician Sex Is a Predictor of Reporting Drivers with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities

Rapoport, Mark J.; Herrmann, Nathan; Haider, Sehrish; Sarracini, Carla Zucchero; Molnar, Frank; Frank, Christopher; Masellis, Mario; Tang‐Wai, David F.; Kiss, Alex; Pimlott, Nicholas; Naglie, Gary

doi:10.1111/jgs.12627

Cited by 4 publications

(8 citation statements)

References 7 publications

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“…[14][15][16][17][18][19] Older physicians, male physicians, and those with higher self-reported levels of discomfort with medical uncertainty have been found to be more likely to address driving during appointments with persons with dementia. 12,20 Furthermore, in our earlier work with hypothetical cases, we found that physicians vary greatly in the proportion of patients with dementia whom they report to transportation administrators, with rates ranging from 1.6 to 78.3 per cent in one study, showing substantial nonadherence to the strictly-worded mandatory reporting legislation in a Canadian province. 12 Qualitative research on the driving cessation process in dementia has highlighted limitations of planning abilities in people with dementia as their insight and other cognitive skills decline.…”

Section: Introductionmentioning

confidence: 77%

“…12,20 Furthermore, in our earlier work with hypothetical cases, we found that physicians vary greatly in the proportion of patients with dementia whom they report to transportation administrators, with rates ranging from 1.6 to 78.3 per cent in one study, showing substantial nonadherence to the strictly-worded mandatory reporting legislation in a Canadian province. 12 Qualitative research on the driving cessation process in dementia has highlighted limitations of planning abilities in people with dementia as their insight and other cognitive skills decline. [21][22][23][24][25] Healthcare providers have been identified as key stakeholders who can increase the understanding of patients and caregivers about the link between dementia and deterioration of driving skills, 21,25,26 address the attendant emotional losses, and engage in practical planning.…”

Section: Introductionmentioning

confidence: 77%

“…[8][9][10] Physicians are often reluctant to report patients with dementia and other medical conditions that affect driving to transportation authorities, even in jurisdictions with mandatory reporting legislation. [11][12][13] This reluctance has been attributed, in part, to the impact of reporting on the doctor-patient relationship and uncertainty about how the condition affects actual driving skills. [14][15][16][17][18][19] Older physicians, male physicians, and those with higher self-reported levels of discomfort with medical uncertainty have been found to be more likely to address driving during appointments with persons with dementia.…”

Section: Introductionmentioning

confidence: 99%

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A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Rapoport¹,

Sarracini

Mulsant

et al. 2019

Health Informatics J

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Clinicians face challenges in deciding which older patients with dementia to report to transportation administrators. This study used a qualitative thematic analysis to understand the utility and limitations of implementing a computer-based Driving in Dementia Decision Tool in clinical practice. Thirteen physicians and eight nurse practitioners participated in an interview to discuss their experience using the tool. While many participants felt the tool provided a useful ‘virtual second opinion’, specialist physicians felt that the tool did not add value to their clinical practice. Barriers to using the Driving in Dementia Decision Tool included lack of integration with electronic medical records and inability to capture certain contextual nuances. Opinions varied about the impact of the tool on the relationship of clinicians with patients and their families. The Driving in Dementia Decision Tool was judged most useful by nurse practitioners and least useful by specialist physicians. This work highlights the importance of tailoring knowledge translation interventions to particular practices.

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Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Rapoport¹,

Sarracini

Mulsant

et al. 2019

Health Informatics J

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“…We conducted an earlier modified Delphi study, Driving and Dementia in Ontario (DADIO) [ 40 , 41 ], in which physician experts in dementia were asked whether or not they would report a patient with mild dementia or MCI to transportation administrators based on 26 hypothetical case scenarios. After 5 iterations, consensus was ultimately obtained for the majority of scenarios, and an algorithm was created to reflect the case scenarios and corresponding expert-derived reporting decisions.…”

Section: Introductionmentioning

confidence: 99%

“…In that study, caregiver concern and abnormal performance on the clock drawing test (CDT) [ 42 ] accounted for 62% of the variance in reporting such patients. We also found that male physicians were 14% more likely to report than their female counterparts [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Rapoport¹,

Sarracini²,

Kiss³

et al. 2018

J Med Internet Res

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BackgroundPhysicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports.ObjectiveThe aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators.MethodsThe study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm.ResultsA total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001).ConclusionsOn the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians.Trial RegistrationClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)

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Developing Physician Consensus on the Reporting of Patients with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities in a Region with Mandatory Reporting Legislation

Rapoport¹,

Naglie²,

Herrmann³

et al. 2014

The American Journal of Geriatric Psychiatry

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Physician Sex Is a Predictor of Reporting Drivers with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities

Cited by 4 publications

References 7 publications

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Developing Physician Consensus on the Reporting of Patients with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities in a Region with Mandatory Reporting Legislation

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