The following is a summary of “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,” published in the November 2023 issue of Primary Care by Borson, et al.
Primary care clinicians (PCCs) often notice a patient having trouble thinking or remembering. This includes people with Alzheimer’s disease or related dementias (ADRD). But starting talks about cognitive changes can be hard for patients, their families, and therapists; all three groups say some things make it hard to talk. As the number of evidence-based treatments for ADRD grows, including multidomain care management and new biotherapies for early-stage AD, it should become normal practice to talk about brain health as part of regular medical care. For a study, researchers did a thorough review to find out what makes it hard to talk about brain health in primary care settings and what makes it easier to do so.
They carefully looked through PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies done in the US between January 2000 and October 2022. The studies examined how people thought about their cognitive abilities and the brain health conversations between doctors and patients before they were officially screened for or diagnosed with mild cognitive impairment or ADRD.
The Mixed Methods Appraisal Tool was used to rate the strength of the included works. A total of 5,547 papers were reviewed, and 22 pieces about 19 studies were chosen. The studies examined how regular people or doctors think about cognition and how providers and patients talk about a patient’s cognitive issues. They came up with 4 main ideas: PCCs don’t want to talk about brain health and cognitive concerns; patients don’t want to bring up cognitive concerns; clinicians don’t always get the evidence they need to make treatment plans that stop cognitive decline; and social and cultural factors affect how people think about brain health and cognition, which in turn affects their clinical engagement. PCCs and their patients don’t usually talk about brain health early on. They need useful tools, methods, and tactics to make these important talks more common.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02185-4