Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence.
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Authors
Foley, Tony
Forsyth, Justin
McLoughlin, Kathleen
Horgan, Linda
Bradley, Colin P
Publication Date
2018-01Journal Title
PloS one
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Volume
13
Issue
10
Pages
e0205580
Language
eng
Type
Article
Physical Medium
Electronic-eCollection
Metadata
Show full item recordCitation
Sinnott, C., Foley, T., Forsyth, J., McLoughlin, K., Horgan, L., & Bradley, C. P. (2018). Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence.. PloS one, 13 (10), e0205580. https://doi.org/10.1371/journal.pone.0205580
Abstract
Objectives: To review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment.
Design: Scoping review of empirical literature focused on primary studies of any design.
Setting: Primary care practice
Participants: PCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia
Measurements: Systematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes.
Results: Eighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient’s quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations.
Conclusion: The increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessation.
Keywords
Humans, Dementia, Physician-Patient Relations, Automobile Driving, Referral and Consultation, Primary Health Care, Physicians, Primary Care, Cognitive Dysfunction
Sponsorship
Road Safety Authority of Ireland
Identifiers
External DOI: https://doi.org/10.1371/journal.pone.0205580
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286294