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Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment
  1. Carol Sinnott1,
  2. Tony Foley2,
  3. Linda Horgan3,
  4. Kathleen McLoughlin2,
  5. Cormac Sheehan2,
  6. Colin Bradley2
  1. 1 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2 Department of General Practice, University College Cork, Cork, Ireland
  3. 3 Department of Occupational Therapy, University College Cork, Cork, Ireland
  1. Correspondence to Dr Carol Sinnott; cs926{at}medschl.cam.ac.uk

Abstract

Objective 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.

  • cognitive dysfunction
  • dementia
  • automobile driving
  • primary health care
  • qualitative research

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/.

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Footnotes

  • Contributors CSi, TF, CB and LH planned the original study, wrote the protocol, won funding and oversaw the original study. CSi, TF, CB, KML, CSh and LH designed, planned and carried out analyses for this paper. CSi drafted this manuscript and revised it in response to critical revisions from all authors. CSi and CB are the co-guarantors of the study. All authors read and approved the final manuscript.

  • Funding This work was supported by the Road Safety Authority of Ireland Research Grant in Traffic Medicine (2016). CSi is funded via a National Institute of Health Research (NIHR) Clinical Lecturer award. Funding sources had no role in the design, analysis or writing of the manuscript for this study. The views expressed are those of the authors and not necessarily those of the Road Safety Authority or the NIHR.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Research ethics approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (ECM 4 (aa) 06/09/16)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.