Development of clinical vignettes to assess healthcare decision-making capacity in elderly with mild cognitive impairment and Alzheimer's disease

IntroductionCognitive impairment can constrict healthcare decision-making capacity, as it affects the ability to understand, appreciate, and reason with information, as well as communication abilities. Therefore, decision-making capacity of elders with mild cognitive impairment or Alzheimer's disease should be carefully assessed when patients are asked to make decisions regarding their health. Vignettes are particularly relevant to assess healthcare decision capacity, since they can come close to real life situations and improve statistical reliability of capacity assessment instruments.ObjectiveThis paper describes the construction and development process of three hypothetical vignettes, to be included in a new Portuguese assessment tool of healthcare decision-making capacity (CAI-Health).MethodFor vignettes’ development, examples from other assessment tools were first reviewed to summarize their text length, language complexity and health information contained. Most prevalent causes of mortality and morbidity in Portuguese elders were then identified, in order to select the health issues to include in CAI-Health’ vignettes. Seven vignettes were developed, and three were selected to be included in CAI-Health. After vignette's selection, these were reviewed by three experienced medical experts, during a focus group.ConclusionVignettes final version include cases of increased complexity, presenting situations of mild cognitive impairment, lung tumor and knee arthrosis.     

Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study

IntroductionWhile high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation.ObjectiveThis randomized controlled study aimed to test the impact of individualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test.MethodTwo phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups.ResultsA simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates.ConclusionThe results are discussed for future research.