How do doctors discuss dementia treatments with patients? Content analysis of the presentation of treatment information, benefits and side effects

Background The benefits and side effects of pharmacological treatments for dementia are inherently difficult to qualify. Little is known about how they are discussed with patients and relatives in consultations, despite this having an impact on shared decision making, understanding of medications, and adherence. This study sought to understand how the benefits and side effects of treatments are communicated in clinical encounters. Methods 29 memory assessment clinic consultations across two UK NHS Trusts were video recorded, involving a total of ten doctors, 29 patients and 32 relatives or supporters. The consultations were analysed using content analysis to identify patterns in communication. Results The findings indicted that whilst there were some common approaches to describing medications –approaches varied in ways that could influence understanding and decision-making. Benefits were most frequently presented as symptom management designed to improve symptoms, focused on memory and cognition. Discussions of risk/benefit, prognosis and shared decision making were not present in all consultations. Conclusions Examining the findings in the context of best practice and guidance there are clear recommendations. Our data showed positive framing of the benefits of dementia treatments by clinicians. There was also a lack of consistency in the way that both benefits and side effects could be described. Recommendations include guidance for discussing dementia medications in ways that promote shared decision making including 1) caution about the use of leading language 2) ensuring consistent and transparent communication of benefits using education and training for clinical staff or patient decision aids where appropriate.