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Patient-Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial
Journal article   Open access   Peer reviewed

Patient-Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial

Jennifer L. Wolff, Debra L. Roter, Cynthia M. Boyd, David L. Roth, Diane M. Echavarria, Jennifer Aufill, Judith B. Vick and Laura N. Gitlin
Journal of general internal medicine : JGIM, v 33(9), pp 1478-1486
01 Sep 2018
DOI: https://doi.org/10.1007/s11606-018-4563-y
PMID: 30022409
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s11606-018-4563-yView
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

General & Internal Medicine Health Care Sciences & Services Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
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. To examine whether a patient-family agenda setting intervention improves primary care visit communication for patients with cognitive impairment Two-group pilot randomized controlled study 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 A self-administered paper-pencil checklist to clarify the role of the companion and establish a shared visit agenda Patient-centered communication (primary); verbal activity, information disclosure including discussion of memory, and visit duration (secondary), from audio recordings of visit discussion 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. Patient-family agenda setting may improve primary care visit communication for patients with cognitive impairment. : NCT02986958.

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40 citations in Scopus

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Health Care Sciences & Services
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