Shifting gears versus sudden stops: Qualitative study of consultations about driving in patients with cognitive impairment

Simple item page
dc.contributor.authorSinnott, Carol
dc.contributor.authorFoley, Tony
dc.contributor.authorHorgan, Linda
dc.contributor.authorMcLoughlin, Kathleen
dc.contributor.authorSheehan, Cormac
dc.contributor.authorBradley, Colin
dc.contributor.funderRoad Safety Authorityen
dc.contributor.funderNational Institute for Health Researchen
dc.date.accessioned2019-10-14T22:10:25Z
dc.date.available2019-10-14T22:10:25Z
dc.date.issued2019-08-21
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.en
dc.description.sponsorshipRoad Safety Authority of Ireland (Grant in Traffic Medicine (2016)); National Institute for Health Research (Clinical Lecturer award)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide024452en
dc.identifier.citationSinnott, C., Foley, T., Horgan, L., McLoughlin, K., Sheehan, C. and Bradley, C. (2019) 'Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment', BMJ Open, 9(8), e024452 (9pp.). DOI: 10.1136/bmjopen-2018-024452en
dc.identifier.doi10.1136/bmjopen-2018-024452en
dc.identifier.eissn2044-6055
dc.identifier.endpage9en
dc.identifier.issued8en
dc.identifier.journaltitleBMJ Openen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8761
dc.identifier.volume9en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttps://bmjopen.bmj.com/content/9/8/e024452
dc.rights©Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectShifting gearsen
dc.subjectSudden stopsen
dc.subjectCognitive impairmenten
dc.subjectConsultationsen
dc.titleShifting gears versus sudden stops: Qualitative study of consultations about driving in patients with cognitive impairmenten
dc.typeArticle (peer-reviewed)en
Files
Original bundle
Now showing 1 - 3 of 3
Thumbnail Image
Name:
e024452.full.pdf
Size:
289.72 KB
Format:
Adobe Portable Document Format
Description:
Published version
Download
Thumbnail Image
Name:
bmjopen-2019-August-9-8--inline-supplementary-material-1 (2).pdf
Size:
159.1 KB
Format:
Adobe Portable Document Format
Description:
Supplementary file 1
Download
Thumbnail Image
Name:
bmjopen-2019-August-9-8--inline-supplementary-material-2 (2).pdf
Size:
81.95 KB
Format:
Adobe Portable Document Format
Description:
Supplementary file 2
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
2.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
General Practice - Journal Articles
Occupational Science & Occupational Therapy - Journal articles