Examining physician-patient-caregiver encounters: the case of Alzheimer's disease patients and family physicians in Israel

Abstract

This study examines the characteristics of physician-patient-caregiver encounters in the presence of dementia and how sociodemographic and professional characteristics of family physicians, and severity of symptoms in patients with dementia affect these encounters. Phone interviews were conducted with 141 Israeli-Jewish family physicians (representing a 66% response rate), who were presented with one of two vignettes describing a 76-year old women with dementia. The two vignettes were identical, except that in the first it was stated that the woman sits quietly and cooperates during the examination whereas in the second she is agitated and uncooperative. Participants were asked to what extent they would ask questions to, inform and involve the patient and caregiver respectively when presented with one of the two vignettes. Findings showed that physicians would address the caregiver more than the patient (both with respect to questions, information and involvement). Moreover, it was found that physicians, who were older and had a higher number of years in the profession, would address the caregiver to a higher degree (compared to the patient) than younger and less experienced physicians. Findings provide direction for understanding medical encounters in the presence of dementia. Theoretical implications for dementia care, for medical encounters, and practical implications are discussed.

Family physicians' perceptions and predictors regarding the competence of a person with Alzheimer's disease

“…Participants could have interpreted the statement to mean that the decision was not to be made exclusively by the person with AD and may have considered that the person with AD was capable to some extent of participating in the process without posing a real danger to himself. Indeed in a study assessing family physicians' interaction pattern in the medical encounter between AD patient-caregiverphysician, we found that patients are involved by the physicians in both instrumental and emotional aspects of the encounter, especially in areas related to information-seeking (Werner et al, 2004).…”

What is the role of the general practitioner towards the family caregiver of a community-dwelling demented relative?

“…On the one hand, the limited use of cognitive-enhancing medication and the importance of reviewing concomitant diseases and therapies was acknowledged [17,18,25] while, on the other, the management of dementia in all its aspects was considered to be frustrating and unrewarding [18Á20,23Á26]. In particular, behavioral disturbances and psychosocial aspects were rated as highly difficult and not necessarily part of their job [15,24,26].…”

“…Regarding the patient, on the one hand, general practitioners acknowledged the limited use of cognitive-enhancing medication and the importance of reviewing concomitant diseases and therapies [17,18,25], but regarding the caregiver, on the other, they found the management of dementia in all its aspects to be frustrating and unrewarding [18Á 20,23,24,26]. General practitioners acknowledged the severe impact of the disease on the caregiver.…”

The status of shared decision making and citizen participation in Israeli medicine

“…In a study by Werner et al, 141 Israeli PCPs were presented with one of two vignettes describing a hypothetical clinical encounter involving a calm and cooperative or agitated and uncooperative Alzheimer's disease patient and her caregiver [19]. PCPs indicated that they would question, inform, and involve the caregiver to a greater extent and more consistently than the patient, particularly when the patient was agitated.…”