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168 Exploring the level of shared decision-making during triadic dementia care
  1. Alejandra Martinez-Pereira1,
  2. Lisa Mistler1,2,
  3. Wambui Moraa Onsando3,
  4. Salar Khaleghzadegan3,
  5. Renata W Yen1,
  6. Brianna Morgan4,
  7. Joshua Chodosh4,
  8. Paul Barr1,3
  1. 1Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, USA
  2. 2Dartmouth Health, Lebanon, USA
  3. 3The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, USA
  4. 4Department of Medicine at NYU Grossman School of Medicine, New York City, USA

Abstract

Introduction Information exchange, rapport, and engagement in goal-setting and decision-making are key to effective interpersonal clinic visit communication for patients living with dementia (PLWD) and care partners (CPs) often present. In the VOiCES3 study, we will describe and determine the impact of interpersonal communication during triadic interactions (clinician-care partner-patient) of PLWD on patient and care partner outcomes. In this abstract, we will present preliminary data on the level of shared decision-making (SDM) and its associated care experiences and health-related outcomes.

Methods Participants were recruited from primary care settings in New Hampshire and New York City. We include patients 50 years of age or older, with mild cognitive impairment through to severe dementia, and their CP who attends visits. We audio-recorded all medical visits of study participants for 12 months. We analyzed recordings using Observer OPTIONMCC, which characterizes the level of SDM for clinicians (0–4) and SDM participation for CPs and patients (0–2). Higher scores indicate a higher level of SDM. PLWD and their CPs also completed a post-visit survey of their care experience, quality of life and CP preparedness.

Results Of 51 dyads recruited to date, we have analyzed 6 visits (6 unique dyads) using OPTIONMCC. CPs were more frequently involved in SDM than PLWD (median score: 1.07 vs 0.5); only goal talk was consistently covered in the the visits. The median Observer OPTIONMCC score for the clinician is 66.1/100; supporting deliberation/forming partnership and eliciting preferences were the least observed items.

Discussion and Conclusion It is early to make definitive conclusions about the level of SDM. By study completion, we will recruit 200 dyads and anticipate analyzing approximately 600 clinic visits.

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