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<title>Alzheimer's Conference / Parkinson's Conference: ADPD 2009 - Prague, March 11-15 - Poster Presentations</title>
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    <td class="content"><h1>Poster Presentations</h1>
    <P><b>Session Title:</b> Alzheimer's Disease (AD) including Non-Cognitive Aspects<br><b>Presentation Date:</b> Friday, March 14 – Saturday, March 15, 2009</P><h2 align='left'><b>CHARACTERIZING THE ADVOCATE IN THREE PERSON DECISION-MAKING DISCOURSE FOR PATIENTS WITH DEMENTIA</b></h2>
<p align='left'><b>D. Brauner</b>, A. Mayo<br>
<em>The University of Chicago, Medicine, Chicago, United States</em></p><br>
<p align='justify'>I<b>ntroduction:</b> 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.<br><b><b>Methods: </b></b> 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.<br><b><b>Results: </b></b> 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.<br><u>Hierarchy of Types of Presentation:</u><br> <ul> <li>Phatic </li> <li>Back - channeling </li> <li>Asks Question (clarification from clinician to patient to check understanding or correct confusion) </li> <li>Provide information (Historical Symptoms) </li> <li>Provide interpretation (Past choices Values Prognosis Decision process) </li> <li>Provide advice/opinion. </li> </ul><u>Hierarchy of Types of Prompts:</u><br> <ul> <li>Phatic </li> <li>Signaling agreement to previous presentation </li> <li>Direct question asked by patient </li> <li>Direct question asked by clinician </li> <li>Confusion expressed by patient </li> <li>Confusion expressed by clinician </li> <li>Delayed response by patient - nonverbal </li> <li>Apparent confusion by the advocate </li> <li>No evident prompt. </li> </ul><b><b>Conclusion: </b></b> 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.<br><br></p>
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