Session Title: Alzheimer's Disease (AD) including Non-Cognitive Aspects
Presentation Date: Friday, March 14 – Saturday, March 15, 2009
CHARACTERIZING THE ADVOCATE IN THREE PERSON DECISION-MAKING DISCOURSE FOR PATIENTS WITH DEMENTIA
D. Brauner, A. Mayo
The University of Chicago, Medicine, Chicago, United States
Introduction: Our purpose is to characterize the role of the Advocate, as an alternative model to surrogacy, for patients with dementia in an interaction we call: Three-Person Decision-Making Discourse.
Methods: Participants were patients with dementia who had been referred for joint injection for arthritic pain and were accompanied by a caregiver, whom we call the Advocate. They participated in two informed consent conversations. Each of the Advocates presentations was characterized as to the type and what prompted the presentation. A taxonomy of the types of presentation and prompts was created using a consensus method. Each presentation was then scored as to its type and prompt.
Results: Eight videotaped conversations were analyzed. Taxonomies were developed based on the Advocate's presentations and placed in a Hierarchy based on how they impacted on the patient's autonomy.
Hierarchy of Types of Presentation:
Hierarchy of Types of Prompts:
- Back - channeling
- Asks Question (clarification from clinician to patient to check understanding or correct confusion)
- Provide information (Historical Symptoms)
- Provide interpretation (Past choices Values Prognosis Decision process)
- Provide advice/opinion.
Conclusion: Developing a taxonomy of types and prompts we can better understand the role of the Advocate in Three-Person Decision Making Discourse and begin to create expectations to maintain the maximal autonomy of the patient with dementia.
- Signaling agreement to previous presentation
- Direct question asked by patient
- Direct question asked by clinician
- Confusion expressed by patient
- Confusion expressed by clinician
- Delayed response by patient - nonverbal
- Apparent confusion by the advocate
- No evident prompt.