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Barriers and Facilitators for Guidelines with Depression and Anxiety in Parkinson’s Disease or Dementia

  • Zahra Goodarzi (a1) (a2), Heather M. Hanson (a1) (a3), Nathalie Jette (a1) (a4) (a5), Scott Patten (a1) (a6) (a7), Tamara Pringsheim (a1) (a4) (a5) (a6) (a7) (a8) and Jayna Holroyd-Leduc (a1) (a2)...


Our primary objective was to understand the barriers and facilitators associated with the implementation of high-quality clinical practice guidelines (CPGs) for depression and anxiety in patients with dementia or Parkinson’s disease (PD). We conducted focus groups or interviews with participants experiencing dementia or PD, their caregivers, and physicians in Calgary, Alberta, and applied the theoretical domains framework and behaviour change wheel to guide data collection and perform a framework analysis. Thirty-three physicians and seven PD patients/caregivers participated. We report barriers and facilitators to the implementation of guideline recommendations for diagnosis, management, and the use of the guidelines. An overarching theme was the lack of evidence for depression or anxiety disorders in dementia or PD, which was prominent for anxiety versus depression. Patients noted difficulties with communicating symptoms and accessing services. Although guidelines are available, physicians have difficulty implementing certain recommendations due primarily to a lack of evidence regarding efficacy.

Notre principal objectif était de comprendre les barrières et les facilitateurs associés à l’application de guides de pratique clinique (GPC) de haute qualité pour la dépression et l’anxiété chez les patients atteint de démence ou de la maladie de Parkinson (MP). Des groupes de discussion et des entrevues ont été réalisés avec des participants atteints de démence ou de la MP, leurs soignants et les médecins impliqués dans les soins de ces patients à Calgary (Alberta). Le cadre conceptuel des domaines théoriques et le Behaviour Change Wheel ont été utilisés pour guider la collecte des données et l’analyse du cadre conceptuel. Au total, 33 médecins, 7 patients et leurs aidants ont participé à l’étude. Les barrières et les facilitateurs pour l’application des recommandations des GPC liées au diagnostic, à la gestion et à l’utilisation des lignes directrices ont été rapportés. L’insuffisance des données concernant les troubles anxieux et dépressifs dans la démence et la MP constituaient un thème dominant dans les résultats. Ce constat était particulièrement évident en matière de troubles anxieux. Les patients ont aussi mentionné des difficultés à communiquer leurs symptômes et à accéder aux services. Bien que des guides de pratiques soient disponibles, les médecins éprouvent quelques difficultés dans l’application de certaines recommandations, ces difficultés étant surtout dues au manque de données probantes disponibles.

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Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Dr. Zahra Goodarzi #1104-South Tower Foothills Medical Centre 3301 Hospital Drive Calgary, AB NW T2N 2T9. <>


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The authors thank the many participants of the study for their time, dedication, and openness to the research project. We also thank Monika Khoury-Dool (MK), administrative assistant, for her transcription of the interviews and focus groups.

Funding & Disclosures. This work was supported by a grant from Alberta Innovates Health Solutions – Knowledge to Action Grant (201400559). This project was a component of the Masters Graduate Thesis for ZG. ZG has received funding by Canadian Institutes for Health Research – Canadian Graduate Student Scholarship, Alberta Innovates Health Solutions Clinician Fellowship Award, Canadian Society for Clinical Investigation Resident Research Award, Alberta Government Graduate Student Award, and Western Regional Training Centre affiliate award. HH has no disclosures. SP holds funding from Hotchkiss Brain Institute (HBI), CIHR, and a grant co-funded by the University of Calgary HBI and Pfizer Canada. TP has an unrestricted educational grant from Shire Canada. TP has research grant support from Sick Kids Foundation, Alberta Health Services Mental Health Strategic Clinical Network, Hotchkiss Brain Institute, and Canadian Institutes for Health Research. NJ holds a Canada Research Chair Tier 2 in Health Services Research and holds research grants from the Canadian Institutes of Health Research, the University of Calgary Cumming School of Medicine, Department of Clinical Neurosciences, and HBI. JHL holds funding from the Canadian Institutes of Health Research and Alberta Innovates Health Solutions, and is an associate editor for the Canadian Medical Association Journal.

Authors’ Roles. ZG and JHL completed and submitted the ethics application to the local CHREB on behalf of the authors. HH and JHL assisted in the focus groups by providing the field notes and reviewing debriefing. Transcription was completed by MK and ZG. All transcripts were reviewed word by word by ZG and compared to the recordings to ensure no errors. JHL and HH performed validity check of coding. JHL and HH reviewed all coding and associated quotes. The TDF domains, barriers, and facilitators were assigned and reviewed by ZG, JHL, and HH. ZG, HH, SP, TP, NJ, and JHL provided input and reviewed the proposal, protocol, analysis, and manuscript. All authors had access to the data, and reviewed and approved the final manuscript. ZG, JHL, and HH had full access to the data in the study and take responsibility for the integrity and accuracy of the data.



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