Talking about fitness to drive in patients with cognitive impairment: Current approaches and possible improvement strategies for a general practice setting.

Problem

Driving facilitates independence and social engagement, contributing to quality of life and well-being. However, with 11.3% of Irish adults over 50 years living with cognitive impairment, there are issues for many around continuing to drive. The General Practitioner (GP) is responsible for driving assessment, in accordance with guidelines set out by the Road Safety Authority. Often, the most challenging situation for the GP is when a person presents with a questionable or mild cognitive impairment/dementia. Given the importance of driving, discussions between GPs and patients on fitness to drive can be fraught - with up to one in five people changing GP when driving licence health certification was not approved. In addition, guidelines on fitness to drive offer little direction regarding how to communicate with patients on this sensitive topic, which may lead to clinicians’ reluctance to tackle the issue. The aim of this research, funded by the Road Safety Authority, is to develop evidence-based material to support essential communication between GPs and people with cognitive impairment, including dementia, regarding fitness to drive.

Approach

The study comprises three phases including: (1) a scoping study to determine the existing evidence on communication techniques used to discuss fitness to drive with people living with cognitive impairment in a general practice setting; (2) semi-structured qualitative interviews with GPs (n=15-18) to examine their experience of discussing fitness to drive with patients where cognitive impairment is a concern, using case-based data; (3) qualitative interviews with people living with cognitive impairment/family carers (n=8-10) to explore their experience discussing fitness to drive with their GP.

Findings

Findings from phase one, an appraisal of 4427 empirical records obtained as part of the scoping study to review the existing evidence on communication techniques, will be presented. Data from all phases of the study will be used to develop new training material for GPs.

Consequences

This research addresses an urgent need for evidence-based communication strategies to help GPs discuss cognitive impairment and fitness to drive in a positive, proactive way and encourage early assessment of fitness to drive, to maximise safety for the person and for other road users.