UNO-UMCG: Decision-making for the pharmacologic treatment of problem behaviour in patients with dementia
Type of assignment: MA
Internal or external: external Internal/external: location Groningen
Maximum number of students: 1
Individual collecting of data? Yes
Type of research: qualitative
Description of the assignment:
Organization: UNO-UMCG & UMCG (https://huisartsgeneeskunde-umcg.nl/uno-umcg), department of General Practice & Elderly Care Medicine, Groningen
Background: Patients with dementia are often admitted to nursing homes due to neuropsychiatric symptoms (NPS). These patients have insufficient cognitive skills and are therefore no longer able to make medical decisions themselves. NPS can be treated with psychotropic drugs, but the efficacy of these drugs is limited and they are often associated with serious side effects. The current guidelines advocate the use of psychosocial interventions as first treatment of NPS with a limited and selective use of psychotropic drugs. Nevertheless, the use of psychotropic drugs in Dutch nursing homes is still high. The decision to prescribe these drugs in the final phase of the disease is often taken by the physician in consultation with the nursing staff/psychologist. Usually the legal representative, this is in most cases the informal caregiver, is only consulted at the end of the decision-making process. However, previous research indicated that 16% of the informal caregivers are not consulted at all, and 19% of the informal caregivers would have made the opposite decision. In addition to the legal obligation to view the informal caregivers as a representative of the patient, there are other reasons why involvement of these caregivers in treatment decisions is useful. The informal caregiver knows the needs and wishes of the patient and is able to take these into account during the decision-making or can adjust the (psychosocial) interventions to the patient’s preferences. This can lead to an improvement of the treatment of NPS and a decrease of the (incorrect) use of psychotropic drugs, the use of better alternative care and a proper selection of psychosocial treatments.
There is no literature available on the role of informal caregiver in drug (dose) changes or discontinuation of drugs, although the need for this has already been established. Caregivers can be involved in the prescribing of psychotropic drugs in different ways: the doctor can make a decision, the caregiver can only be "informed", consent can be obtained or the decision is taken jointly (shared decision making). Research is needed to gain insight into the decision-making process regarding the treatment of psychotropic drugs. Especially the needs of caregivers with regards to decision-making need to be identified and determined which decision-making model they prefer.
1. How do the different stakeholders (physician, nurse, informal caregiver and if applicable psychologist) view the decision making process:
a. how do they want to be involved
b. Is there a difference between the preferences of the informal caregivers (spouses/children)
2. What are the barriers and facilitators experienced by the stakeholders in the current decision making process?
Method: In-depth interviews with physician, informal caregiver, nurse and (if applicable) psychologist
Who are we looking for? We are looking for a communicative Dutch speaking student who is willing to travel to the different nursing homes and likes to work in a multidisciplinary team!
What are we offering? Parts of the assignment can be done from home or at the department of General Practice & Elderly Care Medicine, travelling to the nursing homes will be compensated, transcribing the interviews can be outsourced!
More information?: Contact: Sarah Janus, firstname.lastname@example.org, 0626617977
Supervisor: C.H. Drossaert