272‘It’s Tricky’. General Practitioners’ (GPs’) Experience of Talking to Patients with Mild Cognitive Impairment about Fitness to Drive in Ireland

Abstract

Background: Driving contributes to quality of life and wellbeing. However, for 11.3% of adults over 50 living with cognitive impairment, there are issues regarding continuing to drive. The GP plays a key advisory role but there is limited evidence regarding GPs experience and a lack of guidance outlining how best to communicate with people living with MCI about driving. This paper, part of a larger study, addresses this gap with a focus on Irish GPs. Method(s): One-to-one, semi-structured interviews were conducted with GPs working in Ireland. Interviews included the use of stimulated chart recall and were conducted until data saturation was reached. Data was thematically coded by two researchers using NVIVO. Result(s): A maximum variation sample of 12 GPs participated. Almost all considered talking about FTD in the context of MCI to be 'tricky'. Challenges centred on a desire to preserve the doctor-patient relationship and the person's mobility and independence whilst protecting the safety of road users. GPs outlined the negative consequences for all when a person is no longer considered fit to drive, noting that family involvement can be both positive and negative. GPs described incidents of collusion and subterfuge between them and families. Patient mobility between GPs for the purpose of sign off as 'fit to drive' is relatively common. Where unsure, GPs advised on referral to an independent assessor. Concern regarding the GP's role in the process, reporting requirements and medical-legal issues were shared. Practical tips for communication and practice protocols were discussed. GPs would appreciate further training. Conclusion(s): The study highlights the challenges experienced by GPs when talking about FTD with people living with MCI and will inform the development of educational material and guidance. The findings raise questions regarding ethics, the diagnosis of MCI and its association with dementia in the context of driving risk.