Show simple item record

dc.contributor.authorSinnott, Carolen
dc.contributor.authorFoley, Tonyen
dc.contributor.authorHorgan, Lindaen
dc.contributor.authorMcLoughlin, Kathleenen
dc.contributor.authorSheehan, Cormacen
dc.contributor.authorBradley, Colinen
dc.date.accessioned2019-09-09T23:30:32Z
dc.date.available2019-09-09T23:30:32Z
dc.date.issued2019-08-21en
dc.identifier.issn2044-6055
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/296651
dc.description.abstractOBJECTIVE: 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. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated. METHODS: Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method. RESULTS: 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. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs. CONCLUSION: 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 discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.
dc.description.sponsorshipThis work was supported by the Road Safety Authority of Ireland Research Grant in Traffic Medicine (2016). CSi is funded via a National Institute of Health Research (NIHR) Clinical Lecturer award. Funding sources had no role in the design, analysis or writing of the manuscript for this study. The views expressed are those of the authors and not necessarily those of the Road Safety Authority or the NIHR.
dc.format.mediumElectronicen
dc.languageengen
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectHumansen
dc.subjectPhysician-Patient Relationsen
dc.subjectQualitative Researchen
dc.subjectAutomobile Drivingen
dc.subjectIrelanden
dc.subjectInterviews as Topicen
dc.subjectGeneral Practitionersen
dc.subjectCognitive Dysfunctionen
dc.titleShifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment.en
dc.typeArticle
prism.issueIdentifier8en
prism.publicationDate2019en
prism.publicationNameBMJ openen
prism.startingPagee024452
prism.volume9en
dc.identifier.doi10.17863/CAM.43699
dcterms.dateAccepted2019-07-30en
rioxxterms.versionofrecord10.1136/bmjopen-2018-024452en
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-08-21en
dc.contributor.orcidSinnott, Carol [0000-0002-8620-7461]
dc.contributor.orcidBradley, Colin [0000-0002-3595-9567]
dc.identifier.eissn2044-6055
rioxxterms.typeJournal Article/Reviewen


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record

Attribution-NonCommercial 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial 4.0 International