Impact of Patient Mild Cognitive Impairment on Physician Decision-Making for Treatment

Article type: Research Article

Authors: Blair, Emilie M.^{a; c} | Zahuranec, Darin B.^b | Langa, Kenneth M.^{c; d; e; f} | Forman, Jane^{c; d; e} | Reale, Bailey K.^c | Kollman, Colleen^g | Giordani, Bruno^h | Levine, Deborah A.^{b; c; d; *}

Affiliations: [a] University of Michigan (U-M), Ann Arbor, MI, USA | [b] Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA | [c] Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA | [d] Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA | [e] VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [f] Institute for Social Research, U-M, Ann Arbor, MI, USA | [g] Kollman Research Services, Ann Arbor, MI, USA | [h] Department of Psychiatry and Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI, USA

Correspondence: [*] Correspondence to: Deborah A. Levine, MD, MPH, University of Michigan Division of General Medicine, North Campus Research Complex, 2800 Plymouth Road, 16-430W, Ann Arbor, MI 48109-2800, USA. Tel.: +1 734 936 5216; E-mail: deblevin@umich.edu.

Abstract: Background:Older patients with mild cognitive impairment (MCI) should receive evidence-based treatments when clinically indicated. However, patients with MCI appear less likely than cognitively normal patients to receive evidence-based treatments. Objective:To explore the influence of a patient’s MCI diagnosis on physician decision-making. Methods:Qualitative study of 18 physicians from cardiology, neurology, and internal medicine using semi-structured interviews. We sought to understand whether and how a patient’s having MCI has influenced physicians’ decisions about five categories of treatments or tests (surgery, invasive tests, non-invasive tests, rehabilitation, and preventive medication). We used qualitative content analysis to identify the unifying and recurrent themes. Results:Most physician participants described MCI as influencing their recommendations for at least one treatment or test. We identified two major themes as factors that influenced physician recommendations in patients with MCI: Physicians assume that MCI patients’ decreased cognitive ability will impact treatment; and physicians assume that MCI patients have poor health status and physical functioning that will impact treatment. These two themes were representative of physician beliefs that MCI patients have impaired independent decision-making, inability to adhere to treatment, inability to communicate treatment preferences, and increased risk and burden from treatment. Conclusion:A patient’s MCI diagnosis influences physician decision-making for treatment. Some physician assumptions about patients with MCI were not evidence-based. This phenomenon potentially explains why many patients with MCI get fewer effective treatments or tests than cognitively normal patients. Interventions that improve how physicians understand MCI and make decisions for treatments in patients with MCI are needed.

Keywords: Aging, decision making, mild cognitive impairment, treatment

DOI: 10.3233/JAD-200700

Journal: Journal of Alzheimer's Disease, vol. 78, no. 4, pp. 1409-1417, 2020