Published in:
01-09-2018 | Original Research
Patient–Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial
Published in: Journal of General Internal Medicine | Issue 9/2018
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Background
Establishing priorities for discussion during time-limited primary care visits is challenging in the care of patients with cognitive impairment. These patients commonly attend primary care visits with a family companion.
Objective
To examine whether a patient–family agenda setting intervention improves primary care visit communication for patients with cognitive impairment
Design
Two-group pilot randomized controlled study
Participants
Patients aged 65 + with cognitive impairment and family companions (n = 93 dyads) and clinicians (n = 14) from two general and one geriatrics primary care clinic
Intervention
A self-administered paper-pencil checklist to clarify the role of the companion and establish a shared visit agenda
Measurements
Patient-centered communication (primary); verbal activity, information disclosure including discussion of memory, and visit duration (secondary), from audio recordings of visit discussion
Results
Dyads were randomized to usual care (n = 44) or intervention (n = 49). Intervention participants endorsed an active communication role for companions to help patients understand what the clinician says or means (90% of dyads), remind patients to ask questions or ask clinicians questions directly (84% of dyads), or listen and take notes (82% of dyads). Intervention dyads identified 4.4 health issues for the agenda on average: patients more often identified memory (59.2 versus 38.8%; p = 0.012) and mood (42.9 versus 24.5%; p = 0.013) whereas companions more often identified safety (36.7 versus 18.4%; p = 0.039) and personality/behavior change (32.7 versus 16.3%; p = 0.011). Communication was significantly more patient-centered in intervention than in control visits at general clinics (p < 0.001) and in pooled analyses (ratio of 0.86 versus 0.68; p = 0.046). At general clinics, intervention (versus control) dyads contributed more lifestyle and psychosocial talk (p < 0.001) and less biomedical talk (p < 0.001) and companions were more verbally active (p < 0.005). No intervention effects were found at the geriatrics clinic. No effect on memory discussions or visit duration was observed.
Conclusion
Patient–family agenda setting may improve primary care visit communication for patients with cognitive impairment.
Trial Registration
ClinicalTrials.gov: NCT02986958