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Qualitative research
Research
The views of public and clinician stakeholders on risk assessment tools for post-stroke dementia: a qualitative study
  1. Eugene Tang1,
  2. Catherine Exley1,
  3. Christopher Price2,
  4. Blossom Stephan1,
  5. Louise Robinson1
  1. 1 Institute of Health and Society, Newcastle University, Newcastle, UK
  2. 2 Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle, UK
  1. Correspondence to Dr Eugene Tang; e.y.h.tang{at}newcastle.ac.uk

Abstract

Objective Stroke-survivors are at increased risk of future dementia. Assessment to identify those at high risk of developing a disease using predictive scores has been utilised in different areas of medicine. A number of risk assessment scores for dementia have been developed but none has been recommended for use clinically. The aim of this qualitative study was to assess the acceptability and feasibility of using a risk assessment tool to predict post-stroke dementia.

Design Qualitative semi-structured interviews were conducted and analysed thematically. The patients and carers were offered interviews at around 6 (baseline) and 12 (follow-up) months post-stroke; clinicians were interviewed once.

Setting The study was conducted in the North-East of England with stroke patients, family carers and healthcare professionals in primary and secondary care.

Participants Thirty-nine interviews were conducted (17 clinicians and 15 stroke patients and their carers at baseline. Twelve stroke patients and their carers were interviewed at follow-up, some interviews were conducted in pairs).

Results Barriers and facilitators to risk assessment were discussed. For the patients and carers the focus for facilitators were based on the outcomes of risk assessment for example assistance with preparation, diagnosis and for reassurance. For clinicians, facilitators were focused on the process that is, familiarity in primary care, resource availability in secondary care and collaborative care. For barriers, both groups focused on the outcome including for example, the anxiety generated from a potential diagnosis of dementia. For the patients/carers a further barrier included concerns about how it may affect their recovery. For clinicians there were concerns about limited interventions and how it would be different from standard care.

Conclusions Risk assessment for dementia post-stroke presents challenges given the ramifications of a potential diagnosis of dementia. Attention needs to be given to how information is communicated and strategies developed to support the patients and carers if risk assessment is used.

  • primary care
  • stroke medicine
  • qualitative research
  • dementia

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-025586

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    Footnotes

    • Twitter @eugeneyhtang

    • Contributors ET conceived the framework for this study. ET collected, analysed and interpreted the data. ET prepared the manuscript for submission. CE helped to conceive the framework for this study and assisted with the analysis of the data and contributed to the drafting of the manuscript. CE also critically reviewed and edited the manuscript. CP helped to conceive the framework for this study, assisted with the analysis of the data and critically reviewed and edited the manuscript. BS helped to conceive the framework for this study, assisted with the analysis of the data and critically reviewed and edited the manuscript. LR helped to conceive the framework for this study, assisted with the analysis of the data and critically reviewed and edited the manuscript.

    • Funding Eugene Tang is supported by a NIHR Doctoral Research Fellowship (DRF-2015-08-006). Louise Robinson is supported by a National Institute for Health Research professorship (NIHR-RP-011-043) and a NIHR Senior Investigator award (NF-SI-0616-10054).

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests LR reports grants from NIHR Professorship award, grants from NIHR Senior Investigator award, outside the submitted work.

    • Ethics approval Ethical Approval was obtained from the London – Hampstead Research Ethics Committee (reference 16/LO/0133).

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

    • Data sharing statement No further data will be made available.

    • Presented at This paper presents independent research funded by the National Institute for Health Research (NIHR).

    • Patient consent for publication Obtained.