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Couch E, Ashford MT, Prina M. Persons With Cognitive Impairment and Care Partner Motivations and Experiences of Undergoing an Amyloid Scan: A Systematic Review of Qualitative Studies. THE GERONTOLOGIST 2024; 64:gnae075. [PMID: 38869891 DOI: 10.1093/geront/gnae075] [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: 09/11/2023] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyloid positron emission tomography scans can enhance the accuracy of dementia diagnoses. However, the perspectives and experiences of people with cognitive impairment and their care partners undergoing an amyloid scan are less well understood. Therefore, this review aimed to identify and summarize qualitative studies exploring patient and care partner experiences of undergoing an amyloid scan. RESEARCH DESIGN AND METHODS We searched Embase, MEDLINE, and PsychInfo in March 2024. Articles were screened for inclusion by 2 reviewers and critically appraised using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Studies. Data from the included studies were synthesized using thematic synthesis. RESULTS We identified 10 papers from 6 studies. We identified 4 themes: (1) motivations for undergoing an amyloid scan, (2) experiences of receiving the result, (3) emotional responses to the result, and (4) actions in light of the scan result. Participants reported undergoing the scan to determine the cause of cognitive impairment. They described the information gained from the scan as helpful but struggled to recall the correct terminology or implications of the scan. Emotional responses to the scan varied depending on the scan result. In light of the scan result, the most common action was making advanced plans; however, this was mainly discussed among participants with elevated amyloid. DISCUSSIONS AND IMPLICATIONS Amyloid scans can provide useful and actionable information. However, learning the scan result could be distressing. Future research is needed to balance the potential benefits and harms of amyloid scans.
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Affiliation(s)
- Elyse Couch
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Miriam T Ashford
- VA Advanced Imaging Research Center, San Francisco Veterans Administration Medical Center, San Francisco, California, USA
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
| | - Matthew Prina
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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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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Abowari-Sapeh ME, Ackah JA, Murphy JL, Akudjedu TN. Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review. J Med Imaging Radiat Sci 2024; 55:307-319. [PMID: 38365469 DOI: 10.1016/j.jmir.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. METHOD An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis. RESULT Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD. DISCUSSION This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments. CONCLUSION The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.
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Affiliation(s)
- Mendes E Abowari-Sapeh
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK; Oncology Department, Research & Development Unit, Royal Cornwall Hospital, Truro, UK
| | - Joseph A Ackah
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK
| | - Jane L Murphy
- Faculty of Health and Social Sciences, Ageing and Dementia Research Centre, Bournemouth University, UK
| | - Theophilus N Akudjedu
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK.
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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. [PMID: 38798126 DOI: 10.1111/jgs.19008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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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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