Skip to main content Accessibility help
×
×
Home

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)...

Abstract

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

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. <zahra.goodarzi@albertahealthservices.ca>

Footnotes

Hide All
*

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.

Footnotes

References

Hide All
Blonder, L. X., & Slevin, J. T. (2011). Emotional dysfunction in Parkinson’s disease. Behavioural Neurology, 24(3), 201217. doi:10.3233/BEN-2011-0329
Bridges, K. W., & Goldberg, D. P. (1984). Psychiatric illness in inpatients with neurological disorders: Patients’ views on discussion of emotional problems with neurologists. British Medical Journal (Clinical Research Edition), 289(6446), 656658.
Broen, M. P., Narayen, N. E., Kuijf, M. L., Dissanayaka, N. N., & Leentjens, A. F. (2016). Prevalence of anxiety in Parkinson’s disease: A systematic review and meta-analysis. Movement Disorders. doi:10.1002/mds.26643
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. A., & Rubin, H. R. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA, 282(15), 14581465.
Calleo, J. S., Kunik, M. E., Reid, D., Kraus-Schuman, C., Paukert, A., Regev, T., … & Stanley, M. (2011). Characteristics of generalized anxiety disorder in patients with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 26(6), 492497. doi:10.1177/1533317511426867
Canadian Task Force on Preventive Health, Joffres, M., Jaramillo, A., Dickinson, J., Lewin, G., Pottie, K., … & Tonelli, M. (2013). Recommendations on screening for depression in adults. CMAJ, 185(9), 775782. doi:10.1503/cmaj.130403
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7, 37. doi:10.1186/1748-5908-7-37
Carson, A. J., Ringbauer, B., MacKenzie, L., Warlow, C., & Sharpe, M. (2000). Neurological disease, emotional disorder, and disability: They are related: A study of 300 consecutive new referrals to a neurology outpatient department. Journal of Neurology, Neurosurgery, and Psychiatry, 68(2), 202206.
Cepoiu, M., McCusker, J., Cole, M. G., Sewitch, M., Belzile, E., & Ciampi, A. (2008). Recognition of depression by non-psychiatric physicians – A systematic literature review and meta-analysis. Journal of General Internal Medicine, 23(1), 2536. doi:10.1007/s11606-007-0428-5
Dissanayaka, N. N., Sellbach, A., Matheson, S., O’Sullivan, J. D., Silburn, P. A., Byrne, G. J., … Mellick, G. D. (2010). Anxiety disorders in Parkinson’s disease: Prevalence and risk factors. Movement Disorders, 25(7), 838845. doi:10.1002/mds.22833
Dobkin, R. D., Menza, M., Allen, L. A., Gara, M. A., Mark, M. H., Tiu, J., … Friedman, J. (2011). Cognitive-behavioral therapy for depression in Parkinson’s disease: A randomized, controlled trial. The American Journal of Psychiatry, 168(10), 10661074. doi:10.1176/appi.ajp.2011.10111669
Fink, P., Hansen, M. S., Sondergaard, L., & Frydenberg, M. (2003). Mental illness in new neurological patients. Journal of Neurology, Neurosurgery, and Psychiatry, 74(6), 817819.
Frisina, P. G., Borod, J. C., Foldi, N. S., & Tenenbaum, H. R. (2008). Depression in Parkinson’s disease: Health risks, etiology, and treatment options. Neuropsychiatric Disease and Treatment, 4(1), 8191.
Gagliardi, A. R., Brouwers, M. C., Palda, V. A., Lemieux-Charles, L., & Grimshaw, J. M. (2011). How can we improve guideline use? A conceptual framework of implementability. Implementation Science, 6, 26. doi:10.1186/1748-5908-6-26
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117. doi:10.1186/1471-2288-13-117
Goodarzi, Z., Mele, B., Guo, S., Hanson, H., Jette, N., Patten, S., … & Holroyd-Leduc, J. (2016). Guidelines for dementia or Parkinson’s disease with depression or anxiety: A systematic review. BMC Neurology, 16(1), 244. doi:10.1186/s12883-016-0754-5
Goodarzi, Z., Mrklas, K. J., Roberts, D. J., Jette, N., Pringsheim, T., & Holroyd-Leduc, J. (2016). Detecting depression in Parkinson disease: A systematic review and meta-analysis. Neurology, 87(4), 426437. doi:10.1212/WNL.0000000000002898
Goodarzi, Z. S., Mele, B. S., Roberts, D. J., & Holroyd-Leduc, J. (2017). Depression case finding in individuals with dementia: A systematic review and meta-analysis. Journal of the American Geriatric Society, 65, 937948. doi:10.1111/jgs.14713
Green, J., & Thorogood, N. (2014). Qualitative methods for health research (3rd ed.). Thousand Oaks, CA: Sage.
Jefferies, K., Owino, A., Rickards, H., & Agrawal, N. (2007). Psychiatric disorders in inpatients on a neurology ward: Estimate of prevalence and usefulness of screening questionnaires. Journal of Neurology, Neurosurgery and Psychiatry, 78(4), 414416. doi:10.1136/jnnp.2006.103044
Kerr, M. P., Mensah, S., Besag, F., de Toffol, B., Ettinger, A., Kanemoto, K., … & International League of Epilepsy Commission on the Neuropsychiatric Aspects of, E. (2011). International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia, 52(11), 21332138. doi:10.1111/j.1528-1167.2011.03276.x
Knapskog, A. B., Barca, M. L., & Engedal, K. (2011). A comparison of the validity of the Cornell Scale and the MADRS in detecting depression among memory clinic patients. Dementia and Geriatric Cognitive Disorders, 32(4), 287294. doi:10.1159/000334983
Larisch, A., Oertel, W. H., & Eggert, K. (2009). Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice. Journal of Neurology, 256(10), 16811688. doi:10.1007/s00415-009-5178-3
Marsh, L. (2013). Depression and Parkinson’s disease: Current knowledge. Current Neurology and Neuroscience Reports, 13(12), 409. doi:10.1007/s11910-013-0409-5
Martinez Garcia, L., Sanabria, A. J., Garcia Álvarez, E., Trujillo-Martin, M. M., Etxeandia-Ikobaltzeta, I., Kotzeva, A., … & Alonso-Coello, P., for the Updating Guidelines Working Group. (2014). The validity of recommendations from clinical guidelines: A survival analysis. CMAJ, 186(16), 12111219. doi:10.1503/cmaj.140547
Sandelowski, M. (2008). Member check. In Given, L. M.. (Ed.), The SAGE encyclopedia of qualitative research methods (pp. 501502). Thousand Oaks, CA: Sage.
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A., on behalf of the Psychological Theory Group. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality and Safety in Health Care, 14(1), 2633. doi:10.1136/qshc.2004.011155
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. doi:10.1186/1748-5908-6-42
Modrego, P. J., & Ferrandez, J. (2004). Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: A prospective cohort study. Archives of Neurology, 61(8), 12901293. doi:10.1001/archneur.61.8.1290
Morgan, D. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA: Sage.
Murphy, K., O’Connor, D. A., Browning, C. J., French, S. D., Michie, S., Francis, J. J., … Green, S. E. (2014). Understanding diagnosis and management of dementia and guideline implementation in general practice: A qualitative study using the theoretical domains framework. Implementation Science, 9, 31. doi:10.1186/1748-5908-9-31
Orgeta, V., Qazi, A., Spector, A., & Orrell, M. (2015). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: Systematic review and meta-analysis. The British Journal of Psychiatry, 207(4), 293298. doi:10.1192/bjp.bp.114.148130
Ownby, R. L., Crocco, E., Acevedo, A., John, V., & Loewenstein, D. (2006). Depression and risk for Alzheimer disease: Systematic review, meta-analysis, and metaregression analysis. Archives of General Psychiatry, 63(5), 530538. doi:10.1001/archpsyc.63.5.530
Pachana, N. A., Egan, S. J., Laidlaw, K., Dissanayaka, N., Byrne, G. J., Brockman, S., … & Starkstein, S. (2013). Clinical issues in the treatment of anxiety and depression in older adults with Parkinson’s disease. Movement Disorders, 28(14), 19301934. doi:10.1002/mds.25689
Pimlott, N. J., Persaud, M., Drummond, N., Cohen, C. A., Silvius, J. L., Seigel, K., … & Dalziel, W. B. (2009). Family physicians and dementia in Canada: Part 1. Clinical practice guidelines: Awareness, attitudes, and opinions. Canadian Family Physician, 55(5), 506507, e501–505.
Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care. Analysing qualitative data. BMJ, 320(7227), 114116.
Ramasubbu, R., Beaulieu, S., Taylor, V. H., Schaffer, A., McIntyre, R. S., & Canadian Network for Mood & Anxiety Treatments Task Force. (2012). The CANMAT task force recommendations for the management of patients with mood disorders and comorbid medical conditions: Diagnostic, assessment, and treatment principles. Annals of Clinical Psychiatry, 24(1), 8290.
Ramasubbu, R., Taylor, V. H., Samaan, Z., Sockalingham, S., Li, M., Patten, S..,.. & Anxiety Treatments Task Force. (2012). The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions. Annals of Clinical Psychiatry, 24(1), 91109.
Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D., & Leentjens, A. F. (2008). A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders, 23(2), 183189. doi:10.1002/mds.21803
Riley, R. J., Burgener, S., & Buckwalter, K. C. (2014). Anxiety and stigma in dementia: A threat to aging in place. The Nursing Clinics of North America, 49(2), 213231. doi:10.1016/j.cnur.2014.02.008
Schiffer, R. B. (2009). Depression in neurological practice: Diagnosis, treatment, implications. Seminars in Neurology, 29(3), 220233. doi:10.1055/s-0029-1223873
Schrag, A., Barone, P., Brown, R. G., Leentjens, A. F., McDonald, W. M., Starkstein, S., … & Goetz, C. G. (2007). Depression rating scales in Parkinson’s disease: critique and recommendations. Movement Disorders, 22(8), 10771092. doi:10.1002/mds.21333
Schrag, A., & Leentjens, A. F. (2012). Parkinson disease: Scales to detect depression in Parkinson disease. Nature Reviews in Neurology, 8(7), 359360. doi:10.1038/nrneurol.2012.96
Schroder, S., Kuessner, D., Arnold, G., Zollner, Y., Jones, E., & Schaefer, M. (2011). Do neurologists in Germany adhere to the national Parkinson’s disease guideline? Neuropsychiatric Disease and Treatment, 7, 103110. doi:10.2147/NDT.S8895
Snowden, M. B., Atkins, D. C., Steinman, L. E., Bell, J. F., Bryant, L. L., Copeland, C., & Fitzpatrick, A. L. (2014). Longitudinal association of dementia and depression. American Journal of Geriatric Psychiatry. doi:10.1016/j.jagp.2014.09.002
Tufford, L., & Newman, P.. (2010). Bracketing in qualitative research. Qualitative Social Work, 11(1), 8096.
Turvey, C. L., Jogerst, G., Kim, M. Y., & Frolova, E. (2012). Cultural differences in depression-related stigma in late-life: A comparison between the USA, Russia, and South Korea. International Psychogeriatrics, 24(10), 16421647. doi:10.1017/S1041610212000816
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Goodarzi et al. supplementary material
Goodarzi et al. supplementary material 1

 Word (581 KB)
581 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed