Lay and professional expectations of cholinesterase inhibitor treatment in the early stage of Alzheimer's disease

Abstract

The objectives of the study were to identify, compare and contrast the expectations of key stakeholders regarding cholinesterase inhibitor treatments prescribed to people with Alzheimer's Disease (AD), and to examine those expectations in the light of recent findings regarding the efficacy and effectiveness of this class of drug. Participants were four older women diagnosed with early stage AD, their lay caregivers, their professional healthcare providers, and pharmacists and policy makers, making a total of 23 participants. Semi-structured interviews were performed in a conversational style designed to elicit accounts of expectations of cholinesterase inhibitors in relation to diagnosis and treatment for AD. The interviews were carried out in the participants' own homes, their places of work or by telephone. A five-member, multidisciplinary team taped, transcribed and coded the interviews using qualitative software in order to identify overarching themes. The study found that although the policy makers and physicians harbored more skeptical or negative expectations, the majority of stakeholders expected that people diagnosed with AD would reap beneficial effects through the use of cholinesterase inhibitors. The study concludes that there is still controversy about the use of cholinesterase inhibitors, particularly in terms of their cost-effectiveness. A clear and ethical argument exists in support of attempts to both modify unrealistic patient expectations where they exist, and to enhance the knowledge base of prescribers. Greater concordance between physicians', patients' and caregivers' treatment goals, and appropriate prescription of these agents in line with available research will require more complete patient and caregiver information on the one hand, and potentially a shift in emphasis to more individualized, clinically focused outcomes, on the other.