Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
PLoS One. 2020 Jan 21;15(1):e0227282. doi: 10.1371/journal.pone.0227282. eCollection 2020.
We aimed to explore clinicians' communication, including the discussion of diagnosis, cause, prognosis and care planning, in routine post-diagnostic testing consultations with patients with Mild Cognitive Impairment (MCI).
Thematic content analysis was used to analyze audiotaped consultations in which 10 clinicians (eight neurologists and two geriatricians) from 7 memory clinics, disclosed diagnostic information to 13 MCI patients and their care partners. We assessed clinician-patient communication regarding diagnostic label, cause, prognosis and care planning to identify core findings.
Core findings were: clinicians 1) differed in how they informed about the MCI label; 2) tentatively addressed cause of symptoms; 3) (implicitly) steered against further biomarker testing; 4) rarely informed about the patient's risk of developing dementia; 5) often informed about the expected course of symptoms emphasizing potential symptom stabilization and/or improvement, and; 6) did not engage in a conversation on long-term (care) planning.
Clinicians' information provision about the underlying cause, prognosis and implications for long-term (care) planning in MCI could be more specific. Since most patients and care partners have a strong need to understand the patient's symptoms, and for information on the prognosis and implications for the future, clinicians' current approach may not match with those needs.
我们旨在探讨临床医生在对轻度认知障碍（MCI）患者进行常规诊断后检测咨询时的沟通情况，包括对诊断、病因、预后和护理计划的讨论。
使用主题内容分析法对 10 名临床医生（8 名神经科医生和 2 名老年病医生）在 7 家记忆诊所进行的 13 次 MCI 患者及其护理伙伴的咨询录音进行了分析。我们评估了临床医生与患者之间关于诊断标签、病因、预后和护理计划的沟通情况，以确定核心发现。
核心发现包括：临床医生 1）在告知 MCI 标签的方式上存在差异；2）试探性地讨论了症状的原因；3）（隐含地）反对进一步的生物标志物检测；4）很少告知患者发展为痴呆的风险；5）经常告知患者症状的预期过程，强调潜在的症状稳定和/或改善；6）未进行长期（护理）计划的对话。
临床医生在 MCI 中提供关于潜在病因、预后和长期（护理）规划影响的信息可以更加具体。由于大多数患者和护理伙伴强烈希望了解患者的症状，以及预后和对未来的影响，因此，临床医生目前的方法可能与这些需求不匹配。
