Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence.

Carol Sinnott,Linda Horgan,Justin Forsyth,Kathleen Mcloughlin,Colin P Bradley,Tony Foley,Maw Pin Tan

doi:10.1371/journal.pone.0205580

Carol Sinnott, Linda Horgan + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0205580

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Journal: PloS one	Publication Date: Oct 15, 2018
Citations: 14	License type: CC BY 4.0

Affiliation: University of Cambridge, University College Cork

Abstract

ObjectivesTo review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment.DesignScoping review of empirical literature focused on primary studies of any design.SettingPrimary care practice.ParticipantsPCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia.MeasurementsSystematic 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.ResultsEighteen 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.ConclusionThe 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.

Highlights

Evidence suggests that, on average, most older people will outlive their driving expectancy by 7–10 years [1] yet it remains rare for a person to plan ahead for the day when they will cease driving [2]
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 primary care physicians (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

Summary

Introduction

On average, most older people will outlive their driving expectancy by 7–10 years [1] yet it remains rare for a person to plan ahead for the day when they will cease driving [2]. With the increased detection and diagnosis of dementia, addressing fitness to drive (FtD) and helping patients with cognitive impairment plan for driving cessation is becoming an increasingly frequent aspect of primary care practice [3, 4]. The transition to driving retirement can be difficult for patients, and primary care physicians (PCPs) perceive it as a problematic topic that can upset the doctor-patient relationship, especially in the context of cognitive impairment [5, 6]. Until the rates of detection, diagnosis and disclosure of cognitive impairment improve, there is a need to equip PCPs with nuanced communication techniques to deal with both of these sensitive topics in the one consultation [8]

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