Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence.

Sinnott, Carol; Foley, Tony; Forsyth, Justin; McLoughlin, Kathleen; Horgan, Linda; Bradley, Colin P · 2018 · DOAJ

DOI: 10.1371/journal.pone.0205580

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Summary

This scoping review examines the empirical evidence regarding fitness-to-drive (FtD) consultations between primary care physicians (PCPs) and patients with cognitive impairment, ranging from mild cognitive impairment to dementia. The study was motivated by the increasing prevalence of cognitive impairment in aging populations and the resulting frequency of FtD discussions in primary care. Despite the clinical importance of these conversations, PCPs often perceive them as problematic, fearing damage to the doctor-patient relationship and lacking confidence in their assessment abilities. The authors aimed to synthesize existing literature to identify challenges, understand patient desires, and evaluate interventions that support PCPs in these sensitive consultations. The researchers employed the Arksey and O’Malley scoping review framework to map the evidence base. They conducted systematic searches across seven databases (including Medline, Cinahl, and PsychINFO) for English-language papers published from inception to December 2016. After screening 4,457 records, 18 primary studies met the inclusion criteria, comprising cross-sectional surveys, pre/post evaluations of educational programs, and qualitative studies from the United States, Canada, Australia, New Zealand, and Ireland. Data were synthesized narratively, aligning quantitative findings with qualitative themes, and methodological quality was appraised using the Mixed Methods Appraisal Tool to ensure studies were not fatally flawed. The review found that while PCPs were generally willing to discuss driving as a first point of contact, they expressed significant discomfort with the actual assessment of driving fitness. Less than a third of Canadian PCPs felt comfortable assessing FtD, and nearly 70% sometimes avoided the topic. Similar low confidence levels were reported in the US and New Zealand. Key barriers included insufficient training, particularly in distinguishing normal aging from early dementia; lack of familiarity with legal reporting obligations and local support resources; and fear of damaging the therapeutic relationship or negatively impacting the patient’s quality of life. Patients, conversely, emphasized a desire to maintain agency in planning for driving cessation. The review also noted that years of clinical experience were positively associated with physician confidence and routine discussion of driving. The significance of these findings lies in the identification of specific gaps in PCP preparedness and the validation of pragmatic educational interventions. Studies evaluating educational programs, such as multimedia workshops and decision aids, demonstrated improvements in physician confidence and knowledge. The authors conclude that addressing PCPs’ discomfort through targeted training and clear guidance on legal and resource frameworks is essential. Enhancing PCP competence will facilitate more collaborative, early-stage discussions about driving cessation, thereby supporting patients in planning for this transition while preserving the integrity of the doctor-patient relationship.

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Topics

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• cognitive impairment
• mci dementia driving