Primary care providers' sources and preferences for cognitive health information in the United States

Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician

BACKGROUND

Primary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer's disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. With the expanding array of evidence-based interventions for ADRD, from multidomain care management to novel biotherapeutics for early-stage AD, incorporating conversations about brain health into routine healthcare should become a standard of care. We conducted a systematic review to identify barriers to and facilitators of brain health conversations in primary care settings.

METHODS

We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies conducted in the US between January 2000 and October 2022 that evaluated perceptions of cognition and provider-patient brain health conversations prior to formal screening for, or diagnosis of, mild cognitive impairment or ADRD. We assessed the quality of the included studies using the Mixed Methods Appraisal Tool.

RESULTS

In total, 5547 unique abstracts were screened and 22 articles describing 19 studies were included. The studies explored perceptions of cognition among laypersons or clinicians, or provider-patient interactions in the context of a patient's cognitive concerns. We identified 4 main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement.

CONCLUSIONS

Early conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.

Dissemination of public health research evidence and guidelines to Australian Early Childhood Education and Care staff: Views about source, content and format

ISSUE ADDRESSED

Effective dissemination of public health research and evidence-based guidelines to Early Childhood Education and Care (ECEC) staff is critical for promoting research transfer and uptake and achieving positive outcomes for children.

METHODS

A cross-sectional study was conducted during August 2021 to March 2022, with a sub-sample of Australian ECEC services participating in a larger survey completed online and via Computer-Assisted Telephone Interview. Survey items assessed: influential source for receiving research, type of content that would influence decisions to adopt research and preferred formats for receiving research.

RESULTS

Overall, 993 service managers or staff from 1984 (50.0%) invited and eligible services completed the larger survey. Of these, 463 randomly allocated services (46.7%) had staff complete the dissemination items. The Australian Children's Education and Care Quality Authority, ECEC agencies and Government Departments were most frequently selected as influential sources of research evidence. Staff were most interested in content providing evidence-based recommendations for future actions and descriptions of health issues addressed. Workshops or conferences and webinars were the preferred format for receiving research.

CONCLUSIONS

Findings highlight the importance of tailoring dissemination strategies to meet ECEC staff needs and engaging influential sources to disseminate research evidence. SO WHAT?: Understanding dissemination preferences of ECEC staff is crucial for supporting uptake of evidence-based health promotion in this setting. By developing tailored strategies based on ECEC preferences, research transfer and evidence-based decision making can be supported more effectively. These findings contribute to bridging the evidence-practice gap and improving the quality of care and health outcomes for children in ECEC settings.

Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners' views

Primary care practitioners (PCPs) do not routinely promote dementia risk reduction. The purpose of this study was to map the published literature on the views of PCPs about dementia risk reduction, in order to identify implementation constructs and strategies crucial to the development of an implementation intervention to support dementia risk reduction in primary care. We undertook a scoping review of the PCPs' views about promoting brain health for reducing dementia risk. We searched MEDLINE, PsycINFO, CINAHL, and Embase for English-language articles published between 1995 and December 2017. We then applied the Consolidated Framework for Implementation Research (CFIR) and matched Expert Recommendations for Implementing Change to the scoping review findings in order to develop a preliminary implementation model. Eight articles reported views of PCPs about dementia prevention. Study findings were mapped to 5 of the 39 CFIR constructs: (i) knowledge and beliefs about dementia risk reduction, (ii) evidence strength and quality, (iii) relative priority, (iv) available resources, and (v) external policy and incentives. The findings suggest implementation strategies to consider in our preliminary model include (i) educational meetings, (ii) identifying and preparing champions, (iii) conducting local consensus discussions, (iv) altering incentive structures, and (v) capturing and sharing local knowledge. There have been few studies about the views of PCPs about dementia risk reduction. Implementation in the primary care setting is fundamental to early identification of risk and supporting preventive practices, but it needs to focus on more than just education for PCPs. We need more up-to-date and in-depth data on the views of PCPs about dementia risk reduction and context-specific analyses of implementation needs. Further research into effective primary care interventions to reduce dementia risk is expected to support implementation efforts.

Hepatitis C patient communication source and modality preferences in the direct-acting antiviral era

Background: Although hepatitis C virus (HCV) treatment has improved dramatically, decision making related to treatment continues to be complex and challenging. Little data exists regarding patient information needs and preferences in the direct-acting antiviral (DAA) era. Methods: We evaluated patient-perceived information needs and preferences when making HCV treatment decisions. A cross-sectional survey was conducted at two Ottawa-based sites: a hospital-located outpatient viral hepatitis clinic, and a community-based HCV patient support program. Results: One hundred and seventeen patients completed the survey: the mean age was 52.1 years (range 23 to 78), and 64% were male, 81.5% were White, 48.6% were on disability support or leave, and 60.3% had a high school education or less. Although traditional sources of health information (e.g., direct communication with health care providers) remain preferred by most, a range of preferences were reported including utilization of newer technologies (e.g., emails, text messages). The telephone was rated as the preferred method of contact for medication reminders, with daily or weekly communication reported as most helpful. White participants, those more highly educated, and those with a higher income all indicated a greater acceptability for e-mail and/or text message communication for medication and appointment reminders. Conclusions: There is no single preferred source or method of communicating with patients. These findings indicate that a tailored multi-pronged approach, including newer technologies, is more likely to effectively educate and communicate with the heterogeneous population of individuals living with HCV.

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification

Background

Implementation science seeks to promote the uptake of research and other evidence-based findings into practice, but for healthcare professionals, this is complex as practice draws on, in addition to scientific principles, rules of thumb and a store of practical wisdom acquired from a range of informational and experiential sources. The aims of this review were to identify sources of information and professional experiences encountered by healthcare workers and from this to build a classification system, for use in future observational studies, that describes influences on how healthcare professionals acquire and use information in their clinical practice.

Methods

This was a mixed studies systematic review of observational studies. DATA SOURCES: OVID MEDLINE and Embase and Google Scholar were searched using terms around information, knowledge or evidence and sharing, searching and utilisation combined with terms relating to healthcare groups. ELIGIBILITY: Studies were eligible if one of the intentions was to identify information or experiential encounters by healthcare workers. DATA EXTRACTION: Data was extracted by one author after piloting with another. STUDY APPRAISAL: Studies were assessed using the Mixed Methods Appraisal Tool (MMAT). PRIMARY OUTCOME: The primary outcome extracted was the information source or professional experience encounter. ANALYSIS: Similar encounters were grouped together as single constructs. Our synthesis involved a mixed approach using the top-down logic of the Bliss Bibliographic Classification System (BC2) to generate classification categories and a bottom-up approach to develop descriptive codes (or “facets”) for each category, from the data. The generic terms of BC2 were customised by an iterative process of thematic content analysis. Facets were developed by using available theory and keeping in mind the pragmatic end use of the classification.

Results

Eighty studies were included from which 178 discreet knowledge encounters were extracted. Six classification categories were developed: what information or experience was encountered; how was the information or experience encountered; what was the mode of encounter; from whom did the information originate or with whom was the experience; how many participants were there; and where did the encounter take place. For each of these categories, relevant descriptive facets were identified.

Conclusions

We have sought to identify and classify all knowledge encounters, and we have developed a faceted description of key categories which will support richer descriptions and interrogations of knowledge encounters in healthcare research.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0564-1) contains supplementary material, which is available to authorized users.

A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting

BACKGROUND

Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care.

PURPOSE

The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings.

METHODS

This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care.

RESULTS

The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care.

CONCLUSIONS

This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.

Promoting cognitive health: a web site review of health systems, public health departments, and senior centers

Growing evidence suggests that healthy behaviors such as being physically active, having a heart healthy diet, and being socially involved may promote cognitive health. The United States has recently begun encouraging such behaviors for that purpose. To help evaluate the diffusion of this policy, we sought to measure a baseline of activity in this area. We examined Web sites of 156 large health care systems, the health departments of all 50 states and the 20 largest US cities, and 181 nationally accredited senior centers, to identify information, products, programs, or services recommended for cognitive health. Among health care systems, 40% promoted cognitive health: 24% recommended mental activity, 20% healthy diets, 20% physical activity, and 16% social involvement. Among health departments, 30% promoted cognitive health in the same ways. Among senior centers, 21% offered strategies, primarily mental activity. Results suggest emerging activity in this area and opportunities for continued development.

A content analysis of cognitive health promotion in popular magazines

Health behaviors, particularly physical activity, may promote cognitive health. The public agenda for health behaviors is influenced by popular media. We analyzed the cognitive health content of 20 United States magazines, examining every page of every 2006-2007 issue of the highest circulating magazines for general audiences, women, men, African Americans, and the health conscious (n = 178). Diet was the greatest focus. Physical activity coverage was limited. Important behavior-related cognitive health risks, including hypertension and diabetes, were not mentioned. Publications for African Americans had little cognitive health content. Coverage of cognitive health was not commensurate with growing evidence that health behaviors may help to maintain it. Findings may be useful to public health officials, health care providers, non-profit organizations that promote cognitive health, individuals evaluating cognitive health information in popular media, and those responsible for magazines or other media.

Ethnically Diverse Older Adults' Beliefs about Staying Mentally Sharp

This study examined diverse older adults' ( n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos, and Vietnamese Americans. All groups mentioned benefits of social interaction. All groups, especially Chinese and African Americans, mentioned benefits of community engagement. Participants in all groups expressed their belief that mental stimulation, particularly reading, promoted cognitive health; African Americans and Whites were especially likely to say that mental exercises (e.g., puzzles) were useful. Results suggest opportunities for education about potential cognitive health benefits of being socially connected through senior center activities and volunteer programs.

Prevention of Cognitive Impairment

The public is increasingly inundated with suggestions on how they can reduce their risk of developing cognitive impairment or dementia and are turning to physicians for advice. This study examines physicians’ perceptions and practices related to reducing cognitive impairment or dementia risk. Data from Porter Novelli’s 2008 DocStyles survey are used to examine physicians’ perceptions and practices related to this issue. About 40% of physicians reported discussing concerns about cognitive impairment often or very often with adult patients without dementia. The majority advised patients to reduce risk through physical activity, mental stimulation, and healthy diet. These data shed light on physicians’ perceptions and practices related to reducing cognitive impairmentrisk among their patients. Increased information about this issue may inform development of and access to educational materials to meet physicians’ needs to address patient concerns related to reducing cognitive impairment or dementia risk.