Shifting gears versus sudden stops: a qualitative study of consultations about driving in patients with cognitive impairment

Conference:

SAPC ASM 2018 - London

Talk Code:

1E.2

Presenter:

Carol Sinnott

Twitter:

@cmsinnott

Co-authors:

Tony Foley, Kathleen McLoughlin, Cormac Sheehan, Linda Horgan, Colin Bradley.

Author institutions:

THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK; Department of General Practice, University College Cork, Cork, Ireland

Problem

General Practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult, and potentially damaging to the physician-patient relationship. In this study, we explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated.

Approach

Individual qualitative interviews were conducted with GPs and patients in the Republic of Ireland. GPs were purposively sampled by length-of-time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services, participating general practices, and social media. Interviews were audio-recorded, transcribed, and double-coded by the multidisciplinary research team using a thematic approach.

Findings

The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation, or by patients who urgently needed a medical report for an expiring driving license. GPs with more relational continuity with patients were better placed to adopt the former strategy, rather than waiting for crisis consultations to occur. The risk of acrimony was greater in the latter scenario, especially if patient’s expectations were not met. Patients called for greater clarity and empathy for the threat of driving cessation by GPs to further mitigate the risk of acrimony in FtD consultations.

Consequences

GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit planning and acknowledgement of the impact of driving cessation that may be experienced by patients as an outcome to these consultations.

Submitted by:

Carol Sinnott

Funding acknowledgement:

Carol Sinnott is funded through an NIHR Clinical Lectureship in General Practice. This study was funded by the Road Safety Authority of Ireland, via the Royal College of Physicians of Ireland.