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Wetle TT, Van Houtven CH, Shepherd-Banigan ME, Belanger E, Couch E, Sorenson C, Gadbois EA, Burke JR, Jutkowitz E, O'Brien EC, Plassman BL. Beta amyloid PET scans for dementia diagnoses: Practice and research implications from CARE-IDEAS. J Am Geriatr Soc 2024; 72:2981-2988. [PMID: 38798126 PMCID: PMC11461134 DOI: 10.1111/jgs.19008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
Beta amyloid PET scans are a minimally invasive biomarker that may inform Alzheimer's disease (AD) diagnosis. The Caregiver's Reactions and Experience (CARE) study, an IDEAS supplement, aimed to understand experiences of PET scan recipients and their care partners regarding motivations for scans, reporting and interpreting results, and impact of results. Patients with mild cognitive impairment or dementia who agreed to join the CARE-IDEAS study and their care partners participated in a baseline survey and follow-up survey approximately 18 months later, supplemented by in-depth qualitative interviews with subsets of participants. Patients who received scans and volunteered for follow-up research were more likely to be male, better educated, and have higher income than the general population. Survey information was merged with Medicare data. This article integrates findings from several CARE-IDEAS publications and provides implications for practice and research. Although most participants accurately reported scan results, they were often confused about their meaning for prognosis. Some participants reported distress with results, but there were no significant changes in measured depression, burden, or economic strain over time. Many respondents desired more information about prognosis and supportive resources. Scan results were not differentially associated with changes in service use over time. Findings suggest a need for carefully designed and tested tools for clinicians to discuss risks and benefits of scans and their results, and resources to support patients and care partners in subsequent planning. Learning of scan results provides a point-of-contact that should be leveraged to facilitate shared decision-making and person-centered longitudinal AD care.
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Affiliation(s)
- Terrie T Wetle
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Megan E Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Emmanuelle Belanger
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elyse Couch
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Corinna Sorenson
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Emily A Gadbois
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - James R Burke
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Neurology, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Eric Jutkowitz
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
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Couch E, Zhang W, Belanger E, Shepherd-Banigan M, DePasquale N, Van Houtven CH, Gadbois EA, Wetle T. "There has to be more caring": patient and care partner experiences of the disclosure of amyloid-β PET scan results. Aging Ment Health 2024:1-9. [PMID: 38919069 DOI: 10.1080/13607863.2024.2371471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To explore patient and care partner experiences of receiving an amyloid scan result, with a focus on how clinician disclosure practices influenced patient and care partner emotional responses to the scan result and/or diagnosis. METHODS Semi-structured interviews with 38 people with mild cognitive impairment or dementia and 62 care partners who experienced the disclosure of results from an amyloid PET scan as part of the CARE-IDEAS study. We used thematic analysis to analyze interview transcripts. RESULTS We identified four aspects of the disclosure process that could influence patient and care partner emotional experiences of the scan result/diagnosis: (1) mode of delivery, (2) presence of a care partner, (3) clarity of the scan result explanation, and (4) discussion of post-scan treatment and support options. CONCLUSIONS Emotional experiences of an amyloid scan result can vary depending on how results are communicated. These findings support previous efforts to develop standard disclosure protocols. Scan results should be delivered in person with the care partner present. Clinicians should give a clear explanation of the result and its implications in an empathetic manner. Options for treatment and support should be discussed for all patients.
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Affiliation(s)
- Elyse Couch
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Wenhan Zhang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Emily A Gadbois
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Terrie Wetle
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Jutkowitz E, Shewmaker P, Ford CB, Smith VA, O'Brien E, Shepherd-Banigan M, Belanger E, Plassman BL, Burke JR, Van Houtven CH, Wetle T. Association between results of an amyloid PET scan and healthcare utilization in individuals with cognitive impairment. J Am Geriatr Soc 2024; 72:707-717. [PMID: 38069618 DOI: 10.1111/jgs.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study reports that amyloid PET scans help providers diagnose and manage Alzheimer's disease and related dementias (ADRD). Using CARE-IDEAS, an IDEAS supplemental study, we examined the association between amyloid PET scan result (elevated or non-elevated amyloid), patient characteristics, and participant healthcare utilization. METHODS We linked respondents in CARE-IDEAS study to their Medicare fee-for-service records (n = 1333). We examined participants' cognitive impairment-related, outpatient, emergency department (ED), and inpatient encounters in the year before compared with the 2 years after the amyloid PET scan. RESULTS Individuals with a non-elevated amyloid scan had more healthcare encounters throughout the overall study period than those with an elevated amyloid scan. Regardless of the amyloid scan result, cognitive impairment-related and outpatient encounters overall decreased, but ED and inpatient encounters increased in the 2 years after the scan compared with the year prior. There was minimal evidence of differences in healthcare utilization between participants with an elevated and non-elevated amyloid scan. CONCLUSIONS There is no difference in change in healthcare utilization between people with scans showing elevated and non-elevated beta-amyloid.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Peter Shewmaker
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily O'Brien
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Duke Margolis Health Policy Center, Duke University, Durham, North Carolina, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - James R Burke
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Duke Margolis Health Policy Center, Duke University, Durham, North Carolina, USA
| | - Terrie Wetle
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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Bélanger E, Jutkowitz E, Shewmaker P, Van Houtven CH, Burke JR, Plassman BL, Shepherd-Banigan M, Couch E, Mills C, Wetle TT. Prevalence and incidence of depressive symptoms and diagnosis of depression as associated with elevated amyloid among Medicare beneficiaries with cognitive impairment. J Affect Disord 2023; 334:293-296. [PMID: 37150216 PMCID: PMC10478508 DOI: 10.1016/j.jad.2023.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/18/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Depression and cognitive impairment commonly co-occur, and it has been hypothesized that the two share pathological processes. Our objective for this study was to determine the relationship between elevated β-amyloid level and the prevalence and incidence of depressive symptoms and diagnosed depression over two years among fee-for-service Medicare beneficiaries with cognitive impairment. METHODS We utilized data from the CARE-IDEAS cohort study (N = 2078) including two measures of depressive symptoms (PHQ-2) and administrative claims data to identify pre-scan and incident depression diagnosis in subsample of fee-for-service Medicare beneficiaries (N = 1443). We used descriptive statistics and Poisson regression models with robust covariance. RESULTS Beneficiaries whose scan results indicated not-elevated β-amyloid were significantly more likely to have been diagnosed with depression pre-scan (46.4 % vs. 33.1 %). There was no significant association between elevated amyloid and the incidence of depressive symptoms or diagnosed depression. LIMITATIONS The sample was limited to Medicare beneficiaries with cognitive impairment. Race/ethnic composition and education levels were not representative of the general population and there was substantial loss to follow-up. Mixed depressive / anxious episodes were captured as diagnoses of depression, potentially overestimating depression in this population. CONCLUSIONS There was a high prevalence and incidence of diagnosed depression in this cohort of Medicare beneficiaries, but the incidence of depressive symptoms and diagnosed depression was not associated with elevated β-amyloid.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI, USA.
| | - Eric Jutkowitz
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI, USA
| | - Peter Shewmaker
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - James R Burke
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Brenda L Plassman
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Elyse Couch
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA
| | - Caroline Mills
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA
| | - Terrie T Wetle
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI, USA
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Couch E, Ashford MT, Zhang W, Prina M. Psychosocial and Behavioral Outcomes for Persons With Cognitive Impairment and Caregivers Following Amyloid-β PET Scan Disclosure: A Systematic Review. Alzheimer Dis Assoc Disord 2023; 37:246-258. [PMID: 37561950 PMCID: PMC10529389 DOI: 10.1097/wad.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Positron emission tomography (PET) scans for amyloid-β can aid in the early and accurate detection of Alzheimer disease. The results of amyloid PET scans could help people with cognitive impairment and caregivers better understand their diagnosis; however, there are concerns that they could also cause psychological harm. METHODS A systematic review of psychosocial and behavioral quantitative outcomes following the disclosure of an amyloid PET scan for persons living with cognitive impairment (subjective cognitive decline, mild cognitive impairment, Alzheimer's Disease, and other dementias) and caregivers. FINDINGS Ten papers were identified from 7 studies. There was little evidence of an association between disclosure and depression. However, persons with mild cognitive impairment and their caregivers with elevated levels of amyloid had an increased risk of distress or anxiety compared with those without elevated amyloid. Participants correctly recalled the scan results; however, it is unclear whether this led to an increased understanding of their diagnosis. We did not identify any studies measuring behavioral outcomes. CONCLUSIONS We found mixed evidence on the relationship between amyloid scans and psychosocial and behavioral outcomes in people with cognitive impairment and caregivers. These findings highlight the need for more methodologically rigorous research on this topic.
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Affiliation(s)
- Elyse Couch
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA
| | - Miriam T. Ashford
- VA Advanced Imaging Research Center, San Francisco Veterans Administration Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, USA
| | - Wenhan Zhang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Matthew Prina
- Department of Health Service and Population Research, King’s College London, London UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Couch E, Belanger E, Gadbois EA, DePasquale N, Zhang W, Wetle T. "I know that my role is going to change": a mixed-methods study of the relationship between amyloid-β PET scan results and caregiver burden. Aging Clin Exp Res 2023; 35:387-397. [PMID: 36484946 PMCID: PMC9735001 DOI: 10.1007/s40520-022-02314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Caregiver burden consists of disease specific and perceived stressors, respectively referred to as objective and subjective indicators of burden, and is associated with negative outcomes. Previous research has found that care partners to persons living with cognitive impairment and elevated levels of amyloid-β, as measured by a positron emission tomography (PET) scan, may experience caregiver burden. AIMS To elucidate the relationship between amyloid scan results and subjective and objective indicators of burden. METHODS A parallel mixed-methods design using survey data from 1338 care partners to persons with mild cognitive impairment (MCI) and dementia who received an amyloid scan from the CARE-IDEAS study; and semi-structured interviews with a subsample of 62 care partners. Logistic regression models were used to investigate objective factors associated with caregiver burden. A thematic analysis of semi-structured interviews was used to investigate subjective indicators by exploring care partners' perceptions of their role following an amyloid scan. RESULTS Elevated amyloid was not associated with burden. However, the scan result influenced participants perceptions of their caregiving role and coping strategies. Care partners to persons with elevated amyloid expected increasing responsibility, whereas partners to persons without elevated amyloid and mild cognitive impairment did not anticipate changes to their role. Care partners to persons with elevated amyloid reported using knowledge gained from the scan to develop coping strategies. All care partners described needing practical and emotional support. CONCLUSIONS Amyloid scans can influence subjective indicators of burden and present the opportunity to identify and address care partners' support needs.
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Affiliation(s)
- Elyse Couch
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
| | - Emmanuelle Belanger
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Health Services, Brown University School of Public Health, Policy & Practice, Providence, RI USA
| | - Emily A. Gadbois
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
| | - Nicole DePasquale
- grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University School of Medicine, Durham, NC USA
| | - Wenhan Zhang
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
| | - Terrie Wetle
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
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Bélanger E, Couch E, Carroll MS, DePasquale N, Gadbois EA, Shepherd-Banigan M, Jutkowitz E, Van Houtven CH, Plassman BL, Wetle TT. Advance directives among cognitively impaired persons who had an amyloid PET scan and their care partners: a mixed-methods study. BMC Palliat Care 2022; 21:194. [PMID: 36336690 PMCID: PMC9638311 DOI: 10.1186/s12904-022-01082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Little research exists on the role of β-amyloid PET scans as part of Alzheimer's diagnostic tests and documentation of end-of-life preferences for persons with cognitive impairment. The study objectives were to examine the association of amyloid PET scan results (elevated vs. not elevated amyloid levels) and diagnostic category (mild cognitive impairment vs. dementia) with the likelihood of having an advance directive (reported a median of 4.5 months post-scan); to explore perceptions of PET scan results and their influence on planning for the future among persons with cognitive impairment and their care partners. METHODS Sequential, explanatory mixed-methods design using data from dyads in the CARE-IDEAS study: advance directives as a factor of diagnostic category and scan result using multivariable logistic regression models; thematic analysis of semi-structured interviews with persons with cognitive impairment and care partners to explore how scan results influenced documentation of future healthcare preferences. Participants included 1784 persons with cognitive impairment and care partners from the CARE-IDEAS study, and a subsample of 100 semi-structured telephone interviews. RESULTS 81.6% of dyads reported an advance directive. Non-Hispanic, White participants had higher rates of advance directives. There was no significant association between having an advance directive and scan results. Qualitative analysis provided insight into perceived urgency to have advance directives, evolving healthcare preferences, and the context of completing advance directives. CONCLUSIONS Although amyloid PET scans prompted persons with cognitive impairment and care partners to consider progressive cognitive impairment as part of evolving healthcare preferences, we found substantial variability in the perceived urgency of documentation.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA.
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Elyse Couch
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA
| | - Michaela S Carroll
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily A Gadbois
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Eric Jutkowitz
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Terrie T Wetle
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Fl., Providence, RI, 02903, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Bélanger E, D’Silva J, Carroll MS, Van Houtven CH, Shepherd-Banigan M, Smith VA, Wetle TT. Reactions to Amyloid PET Scan Results and Levels of Anxious and Depressive Symptoms: CARE IDEAS Study. THE GERONTOLOGIST 2022; 63:71-81. [PMID: 35436334 PMCID: PMC9872765 DOI: 10.1093/geront/gnac051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have examined care partners' reactions to their loved ones receiving amyloid-β positron emission tomography (PET) scan results, which can be indicative of Alzheimer's disease. We explored care partners' reactions qualitatively, and checked the association of scan results and diagnostic category (dementia vs mild cognitive impairment [MCI]) with care partner anxious and depressive symptoms through quantitative analysis. RESEARCH DESIGN AND METHODS Using data from 1,761 care partners in the Caregivers' Reactions and Experience, a supplemental study of the Imaging Dementia Evidence for Amyloid Scanning study, we applied an exploratory sequential mixed-methods design and examined the reactions of 196 care partners to receiving amyloid PET scan results through open-ended interview questions. Based on the qualitative content analysis, we hypothesized there would be an association of care partners' depressive (Patient Health Questionnaire-2) and anxious (6-item State-Trait Anxiety Inventory) symptoms with scan results and diagnostic category which we then tested with logistic regression models. RESULTS Content analysis of open-ended responses suggests that when scan results follow the care partner's expectations, for example, elevated amyloid in persons with dementia, care partners report relief and gratitude for the information, rather than distress. Adjusted logistic regression models of survey responses support this finding, with significantly higher odds of anxiety, but not depressive symptoms, among care partners of persons with MCI versus dementia and elevated amyloid. DISCUSSION AND IMPLICATIONS Care partners of persons with MCI reported distress and had higher odds of anxiety after receiving elevated amyloid PET scan results than care partners of persons with dementia. This has the potential to inform clinical practice through recommendations for mental health screening and referrals.
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Affiliation(s)
- Emmanuelle Bélanger
- Address correspondence to: Emmanuelle Bélanger, PhD, Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Floor, Providence, RI 02903, USA. E-mail:
| | - Jessica D’Silva
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Michaela S Carroll
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Terrie T Wetle
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA,Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, Rhode Island, USA
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Shepherd-Banigan M, Ford CB, DePasquale N, Smith VA, Belanger E, Lippmann SJ, O'Brien EC, Van Houtven CH. Making the Informal Formal: Discussing and Completing Advance Care Plans in Care Dyads with Cognitive Impairment. J Palliat Care 2021; 37:289-297. [PMID: 34898305 DOI: 10.1177/08258597211063047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). OBJECTIVES To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. DESIGN AND SUBJECTS We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged >65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. MEASUREMENTS PwCIs' completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs' ACP preferences between PwCIs and care partners. RESULTS In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. CONCLUSIONS Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs' uptake of ADs.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Valerie A Smith
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
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Measurement Properties of the CAPACITY Instrument to Assess Perceived Communication With the Health Care Team Among Care Partners of Patients With Cognitive Impairment. Med Care 2020; 58:842-849. [PMID: 32826749 DOI: 10.1097/mlr.0000000000001363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument measures how care partners perceive themselves to be supported by the patient's health care team and their experiences communicating with the team. OBJECTIVES The objective of this study was to assess the measurement properties (ie, structural validity of the construct and internal consistency) of the CAPACITY instrument in care partners of patients with cognitive impairment, and to examine whether care partner health literacy and patient cognitive impairment are associated with a higher or lower CAPACITY score. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS A total of 1746 dyads of community-dwelling care partners and older adults in the United States with cognitive impairment who obtained an amyloid positron emission tomography scan. MEASURES The CAPACITY instrument comprises 12 items that can be combined as a total score or examined as subdomain scores about communication with the team and care partner capacity-assessment by the team. The 2 covariates of primary interest in the regression model are health literacy and level of cognitive impairment of the patient (Modified Telephone Interview Cognitive Status). RESULTS Confirmatory factor analysis showed the CAPACITY items fit the expected 2-factor structure (communication and capacity). Higher cognitive functioning of patients and higher health literacy among care partners was associated with lower communication domain scores, lower capacity domain scores, and lower overall CAPACITY scores. CONCLUSIONS The strong psychometric validity of the CAPACITY measure indicates it could have utility in other family caregivers or care partner studies assessing the quality of interactions with clinical teams. Knowing that CAPACITY differs by care partner health literacy and patient impairment level may help health care teams employ tailored strategies to achieve high-quality care partner interactions.
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Shepherd-Banigan M, James HJ, Smith VA, Plassman BL, Jutkowitz E, Belanger E, Van Houtven CH. Drivers of Long-Term Care Considerations by Persons With Cognitive Impairment. J Appl Gerontol 2020; 40:648-660. [PMID: 32028815 DOI: 10.1177/0733464820903908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Consideration of place of care is the first step in long-term care (LTC) planning and is critical for patients diagnosed with Alzheimer's disease; yet, drivers of consideration of place of care are unknown. We apply machine learning algorithms to cross-sectional data from the CARE-IDEAS (Caregivers' Reactions and Experience: Imaging Dementia-Evidence for Amyloid Scanning) study (n = 869 dyads) to identify drivers of patient consideration of institutional, in-home paid, and family care. Although decisions about LTC are complex, important drivers included whether patients consulted with a financial planner about LTC, patient demographics, loneliness, and geographical proximity of family members. Findings about consulting with a financial planner match literature showing that perceived financial constraints limit the range of choices in LTC planning. Well-documented drivers of institutionalization, such as care partner burden, were not identified as important variables. By understanding which factors drive patients to consider each type of care, clinicians can guide patients and their families in LTC planning.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham Veterans Affairs (VA) Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA
| | - Hailey J James
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, USA
| | - Valerie A Smith
- Durham Veterans Affairs (VA) Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA
| | - Brenda L Plassman
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA
| | - Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Courtney H Van Houtven
- Durham Veterans Affairs (VA) Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA
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James HJ, Van Houtven CH, Lippmann S, Burke JR, Shepherd-Banigan M, Belanger E, Wetle TF, Plassman BL. How Accurately Do Patients and Their Care Partners Report Results of Amyloid-β PET Scans for Alzheimer's Disease Assessment? J Alzheimers Dis 2020; 74:625-636. [PMID: 32065790 PMCID: PMC7183243 DOI: 10.3233/jad-190922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Amyloid-β PET scans will likely become an integral part of the diagnostic evaluation for Alzheimer's disease if Medicare approves reimbursement for the scans. However, little is known about patients' and their care partners' interpretation of scan results. OBJECTIVE This study seeks to understand how accurately patients with mild cognitive impairment (MCI) or dementia and their care partners report results of amyloid-β PET scans and factors related to correct reporting. METHODS A mixed-methods approach was used to analyze survey data from 1,845 patient-care partner dyads and responses to open-ended questions about interpretation of scan results from a sub-sample of 200 dyads. RESULTS Eighty-three percent of patients and 85% of care partners correctly reported amyloid-β PET scan results. Patients' higher cognitive function was associated with a small but significant decrease in the predicted probability of not only patients accurately reporting scan results (ME: -0.004, 95% CI: -0.007, -0.000), but also care partners accurately reporting scan results (ME: -0.006, 95% CI: -0.007, -0.001), as well as decreased concordance between patient and care partner reports (ME: -0.004, 95% CI: -0.007, -0.001). Content analysis of open-ended responses found that participants who reported the scan results incorrectly exhibited more confusion about diagnostic terminology than those who correctly reported the scan results. CONCLUSION Overall, patients with MCI or dementia showed high rates of accurate reporting of amyloid-β PET scan results. However, responses to questions about the meaning of the scan results highlight the need for improved provider communication, including providing written explanations and better prognostic information.
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Affiliation(s)
- Hailey J. James
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Courtney Harold Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Health Services Research and Development in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Steven Lippmann
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Neurology, School of Medicine, Duke University, Durham, NC, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Health Services Research and Development in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Terrie Fox Wetle
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Brenda L. Plassman
- Department of Neurology, School of Medicine, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
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