Do adapted vignettes improve medical decision‐making capacity for individuals with Alzheimer's disease?

Abstract

Medical decision-making capacity (MDC) is known to decline in individuals with Alzheimer's disease (AD). The vignette method uses hypothetical information as a prerequisite for measuring the capacity to make well-informed decisions to clinical trials. Our aim was to investigate if adapted vignettes can help individuals with mild AD to assimilate information, make decisions and express them in an understandable way, compared to corresponding decisions based on linguistically more demanding vignettes, as measured by the Swedish Linguistic Instrument for Medical Decision-making (LIMD). Two vignettes from LIMD were altered linguistically with the aim to facilitate understanding for individuals with AD. An experimental within-subject design was used to study the influence on MDC of readability (original/adapted vignettes) and content (two different clinical trials). We included 24 patients with mild AD in this prospective study, which read all four vignettes along with a few other tests. This allowed us to investigate the association between MDC and cognitive function. Adapted vignettes did not yield significant differences regarding MDC as compared with original vignettes using a two-way repeated measures analysis of variance. A difference was found between the two clinical trials where LIMD score was significantly higher for Kidney disease than hypertension vignettes. Our results indicate that adapted vignettes may not improve MDC for individuals with mild AD. MDC was affected by which clinical trial the vignettes regarded, which implies that other factors affecting MDC need to be investigated, like length of text and vocabulary used.

Decision-Making Support for People With Alzheimer’s Disease: A Narrative Review

“…Since some studies did not show the effectiveness of decision-making support for people with AD ( Thalen et al, 2017 ; Palmer et al, 2018 ), decision-making support might rather cause their confusion. However, thinking about people with AD and explaining politely when they make decisions are necessary.…”

“…In financial decision-making, semantic memory is linked to financial knowledge, while episode memory and visuospatial ability are related to numeracy ( Gamble et al, 2015 ). Working memory ( Stormoen et al, 2014 ; Thalen et al, 2017 ), short-term verbal memory ( Earnst et al, 2000 ; Thalen et al, 2017 ), verbal knowledge ( Stormoen et al, 2014 ), and semantic knowledge ( Earnst et al, 2000 ) might be involved in medical decision-making capacity. Thus, poor memory may affect decision-making in patients with AD.…”

“…A study demonstrated the effectiveness of simplifying the information in comprehension of consent form in people with mild to moderate AD ( Moro et al, 2020 ). However, the readability of vignette did not improve the medical decision-making in people with mild AD ( Thalen et al, 2017 ). Mueller et al (2019) found that patients with mild AD with explicit information about the risks of a just-made decision in a decision-making task made fewer risky choices and more inclined to make favorable decisions, compared to those without this support.…”

Evidence and practice: a review of vignettes in qualitative research

“…Stacey et al (2014) said that the behaviour demonstrated by health professionals in simulated situations will closely resemble their behaviour in the equivalent clinical situations. Thalén et al (2017) said that although vignettes of clinical situations have been criticised, decision-making regarding a hypothetical situation reflects decision-making in real life. The debate around whether simulation reflects actual behaviours should be recognised and acknowledged as a potential limitation.…”

Determining medical decision-making capacity in brain tumor patients: why and how?

“…Instruments to assess capacity have been tested in neurological populations including brain tumors, 1,4,5,10-13 dementia, 3, Parkinson disease, 18,47,48 neuropsychiatric disorders, 3,23,46 stroke, 49 and MS. 50,51 These instruments usually seek to test 4 abilities underpinning capacity: understanding, appreciation, reasoning, and choice. This can be achieved by tailoring the instrument to real-life (clinical) decisions facing the patient, 3,12,17,33,36,40 but has more often been studied using hypothetical clinical vignettes, 1,4,5,10,11,13,18,[20][21][22][23]25,[27][28][29][30][31][32]34,35,[37][38][39]41,42,45,47,48,[50][51][52][53]…”