Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder

Max A. Feinstein, Richard R. Sharp, David J. Sandness, John C. Feemster, Mithri Junna, Suresh Kotagal, Melissa C. Lipford, Maja Tippmann-Peikert, Bradley F. Boeve, Michael H. Silber, Erik K. St. Louis

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives/Background: Prognostic counseling about the risk for developing overt neurodegenerative disorders for patients with idiopathic REM sleep-behavior disorder (iRBD) and isolated REM sleep without atonia (iRSWA) is difficult, given lack of disease-modifying interventions and uncertainty in accurate prognostication for individuals. We aimed to analyze patient and physician characteristics associated with documented prognostic discussions for patients with iRBD and iRSWA. Patients/Methods: We retrospectively reviewed the medical records for 138 (112 iRBD and 26 iRSWA) patients seen at the Mayo Clinic between 2012 and 2015. We analyzed physician and patient demographics, initial complaint, and other information discussed during office visits. We then comparatively analyzed the impact of physician and patient characteristics on documented prognostic discussions using Chi Square or Fischer's exact test. Results: Mean iRBD patient age was 65.0 ± 13.0, and mean iRSWA age was 58 ± 15 years. Seventy-eight (69.6%) iRBD and 22 (84.6%) iRSWA patients were men. Sixty-two (55%) iRBD and three (12%) iRSWA patients received prognostic counseling about phenoconversion risk. iRBD was a secondary complaint in 67 (59.8%). Patients over age 60 years and those having iRBD as a chief complaint more frequently received prognostic discussions than those with opposite characteristics (all p < 0.05). Patient sex and antidepressant use were not associated with counseling. Sleep neurologists disclosed prognostic information most frequently, with male more likely than female clinicians to disclose prognoses. Conclusions: Several patient and physician characteristics appear to influence documented prognostic counseling for iRBD/RSWA patients. Future studies of iRBD/RSWA patients' preferences are needed to clarify ethically appropriate physician-patient communication concerning prognosis.

Original languageEnglish (US)
Pages (from-to)80-85
Number of pages6
JournalSleep Medicine
Volume62
DOIs
StatePublished - Oct 2019

Fingerprint

REM Sleep Behavior Disorder
Counseling
Physicians
REM Sleep
Office Visits
Patient Preference

Keywords

  • Counseling
  • Ethics
  • Physician-patient relationship
  • Prognosis
  • REM sleep-behavior disorder

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder. / Feinstein, Max A.; Sharp, Richard R.; Sandness, David J.; Feemster, John C.; Junna, Mithri; Kotagal, Suresh; Lipford, Melissa C.; Tippmann-Peikert, Maja; Boeve, Bradley F.; Silber, Michael H.; St. Louis, Erik K.

In: Sleep Medicine, Vol. 62, 10.2019, p. 80-85.

Research output: Contribution to journalArticle

Feinstein, Max A. ; Sharp, Richard R. ; Sandness, David J. ; Feemster, John C. ; Junna, Mithri ; Kotagal, Suresh ; Lipford, Melissa C. ; Tippmann-Peikert, Maja ; Boeve, Bradley F. ; Silber, Michael H. ; St. Louis, Erik K. / Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder. In: Sleep Medicine. 2019 ; Vol. 62. pp. 80-85.
@article{53e8be86aed84010b44dfd54703eebbf,
title = "Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder",
abstract = "Objectives/Background: Prognostic counseling about the risk for developing overt neurodegenerative disorders for patients with idiopathic REM sleep-behavior disorder (iRBD) and isolated REM sleep without atonia (iRSWA) is difficult, given lack of disease-modifying interventions and uncertainty in accurate prognostication for individuals. We aimed to analyze patient and physician characteristics associated with documented prognostic discussions for patients with iRBD and iRSWA. Patients/Methods: We retrospectively reviewed the medical records for 138 (112 iRBD and 26 iRSWA) patients seen at the Mayo Clinic between 2012 and 2015. We analyzed physician and patient demographics, initial complaint, and other information discussed during office visits. We then comparatively analyzed the impact of physician and patient characteristics on documented prognostic discussions using Chi Square or Fischer's exact test. Results: Mean iRBD patient age was 65.0 ± 13.0, and mean iRSWA age was 58 ± 15 years. Seventy-eight (69.6{\%}) iRBD and 22 (84.6{\%}) iRSWA patients were men. Sixty-two (55{\%}) iRBD and three (12{\%}) iRSWA patients received prognostic counseling about phenoconversion risk. iRBD was a secondary complaint in 67 (59.8{\%}). Patients over age 60 years and those having iRBD as a chief complaint more frequently received prognostic discussions than those with opposite characteristics (all p < 0.05). Patient sex and antidepressant use were not associated with counseling. Sleep neurologists disclosed prognostic information most frequently, with male more likely than female clinicians to disclose prognoses. Conclusions: Several patient and physician characteristics appear to influence documented prognostic counseling for iRBD/RSWA patients. Future studies of iRBD/RSWA patients' preferences are needed to clarify ethically appropriate physician-patient communication concerning prognosis.",
keywords = "Counseling, Ethics, Physician-patient relationship, Prognosis, REM sleep-behavior disorder",
author = "Feinstein, {Max A.} and Sharp, {Richard R.} and Sandness, {David J.} and Feemster, {John C.} and Mithri Junna and Suresh Kotagal and Lipford, {Melissa C.} and Maja Tippmann-Peikert and Boeve, {Bradley F.} and Silber, {Michael H.} and {St. Louis}, {Erik K.}",
year = "2019",
month = "10",
doi = "10.1016/j.sleep.2019.03.010",
language = "English (US)",
volume = "62",
pages = "80--85",
journal = "Sleep Medicine",
issn = "1389-9457",
publisher = "Elsevier",

}

TY - JOUR

T1 - Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder

AU - Feinstein, Max A.

AU - Sharp, Richard R.

AU - Sandness, David J.

AU - Feemster, John C.

AU - Junna, Mithri

AU - Kotagal, Suresh

AU - Lipford, Melissa C.

AU - Tippmann-Peikert, Maja

AU - Boeve, Bradley F.

AU - Silber, Michael H.

AU - St. Louis, Erik K.

PY - 2019/10

Y1 - 2019/10

N2 - Objectives/Background: Prognostic counseling about the risk for developing overt neurodegenerative disorders for patients with idiopathic REM sleep-behavior disorder (iRBD) and isolated REM sleep without atonia (iRSWA) is difficult, given lack of disease-modifying interventions and uncertainty in accurate prognostication for individuals. We aimed to analyze patient and physician characteristics associated with documented prognostic discussions for patients with iRBD and iRSWA. Patients/Methods: We retrospectively reviewed the medical records for 138 (112 iRBD and 26 iRSWA) patients seen at the Mayo Clinic between 2012 and 2015. We analyzed physician and patient demographics, initial complaint, and other information discussed during office visits. We then comparatively analyzed the impact of physician and patient characteristics on documented prognostic discussions using Chi Square or Fischer's exact test. Results: Mean iRBD patient age was 65.0 ± 13.0, and mean iRSWA age was 58 ± 15 years. Seventy-eight (69.6%) iRBD and 22 (84.6%) iRSWA patients were men. Sixty-two (55%) iRBD and three (12%) iRSWA patients received prognostic counseling about phenoconversion risk. iRBD was a secondary complaint in 67 (59.8%). Patients over age 60 years and those having iRBD as a chief complaint more frequently received prognostic discussions than those with opposite characteristics (all p < 0.05). Patient sex and antidepressant use were not associated with counseling. Sleep neurologists disclosed prognostic information most frequently, with male more likely than female clinicians to disclose prognoses. Conclusions: Several patient and physician characteristics appear to influence documented prognostic counseling for iRBD/RSWA patients. Future studies of iRBD/RSWA patients' preferences are needed to clarify ethically appropriate physician-patient communication concerning prognosis.

AB - Objectives/Background: Prognostic counseling about the risk for developing overt neurodegenerative disorders for patients with idiopathic REM sleep-behavior disorder (iRBD) and isolated REM sleep without atonia (iRSWA) is difficult, given lack of disease-modifying interventions and uncertainty in accurate prognostication for individuals. We aimed to analyze patient and physician characteristics associated with documented prognostic discussions for patients with iRBD and iRSWA. Patients/Methods: We retrospectively reviewed the medical records for 138 (112 iRBD and 26 iRSWA) patients seen at the Mayo Clinic between 2012 and 2015. We analyzed physician and patient demographics, initial complaint, and other information discussed during office visits. We then comparatively analyzed the impact of physician and patient characteristics on documented prognostic discussions using Chi Square or Fischer's exact test. Results: Mean iRBD patient age was 65.0 ± 13.0, and mean iRSWA age was 58 ± 15 years. Seventy-eight (69.6%) iRBD and 22 (84.6%) iRSWA patients were men. Sixty-two (55%) iRBD and three (12%) iRSWA patients received prognostic counseling about phenoconversion risk. iRBD was a secondary complaint in 67 (59.8%). Patients over age 60 years and those having iRBD as a chief complaint more frequently received prognostic discussions than those with opposite characteristics (all p < 0.05). Patient sex and antidepressant use were not associated with counseling. Sleep neurologists disclosed prognostic information most frequently, with male more likely than female clinicians to disclose prognoses. Conclusions: Several patient and physician characteristics appear to influence documented prognostic counseling for iRBD/RSWA patients. Future studies of iRBD/RSWA patients' preferences are needed to clarify ethically appropriate physician-patient communication concerning prognosis.

KW - Counseling

KW - Ethics

KW - Physician-patient relationship

KW - Prognosis

KW - REM sleep-behavior disorder

UR - http://www.scopus.com/inward/record.url?scp=85072701905&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072701905&partnerID=8YFLogxK

U2 - 10.1016/j.sleep.2019.03.010

DO - 10.1016/j.sleep.2019.03.010

M3 - Article

C2 - 31581066

AN - SCOPUS:85072701905

VL - 62

SP - 80

EP - 85

JO - Sleep Medicine

JF - Sleep Medicine

SN - 1389-9457

ER -