communicating results of cognitive
assessment to patients and healthcare
providers the objectives for this
webinar are number one to review the
preparation and the workflow involved in
delivering assessment results to clients
and health care providers number two to
discuss sample scripts for both negative
and positive results three to understand
the steps required for subsequent care
coordination and lastly to review common
patient questions and answers the
workflow involves four steps the first
is administering the cognitive
assessment tool secondly discussing the
results with the client or patient
thirdly recommending next steps or
appropriate follow-up and lastly
considering providing some written
documentation about the assessment
results to patients and family members
and possibly to physicians and medical
providers as well in terms of
preparation before using an assessment
tool of course you should make sure that
you practice and are comfortable with
all administration and scoring
guidelines of the tool chosen when
providing feedback to patients and
providers about assessment results you
can use parts or all of the scripts
provided in this webinar as a foundation
keep in mind that your exact script may
vary in part depending on your unique
professional role and whether you're
working inside a medical clinic or in a
community health care agency or setting
you will want to prepare ahead of time
by writing down your scripts and
practicing the delivery of the feedback
until you can provide the information
clearly and succinctly and offer
feedback calmly in a matter-of-fact tone
and without anxiety keeping in mind that
any tension or anxiety that you have
could be projected on to clients and
patients altering the way that they
respond you should keep your scripts on
hand at all times along with your
screening tools so you always have them
available for reference when needed it
is also important to never use the words
dementia or Alzheimer's disease in the
context of these assessment tools the
tools are not diagnostic and using these
terms is premature
sure at this stage and can of course
contribute to a client's anxiety and
fear about outcomes it's also important
to avoid being unnecessarily wordy or
over explaining or rationalizing the
process instead the process should be
presented as a standard of care just
like taking blood pressure or ordering
labs it's a good idea to plan for a
variety of client reactions responses
from patients may range from acceptance
to rejection some patients are already
worried about their memory and are
interested in getting answers others may
be surprised by test results but willing
to follow up and some may not be aware
of the problem possibly because they are
forgetting that they're forgetful or
they may not be ready to accept the
information that you present to them if
a patient does not fully accept their
feedback or the recommendations for
follow-up understand that this can be a
very effective compensatory strategy for
example to preserve their sense of self
for many of us the idea of having
cognitive impairment can pose a real
threat to our identities and self-worth
and a lack of full acceptance about test
results can also manage our fears and
anxieties about the future the readiness
of a person to act on these test results
may be a gradual process requiring
multiple interactions between you and
the client ultimately we should also
understand the fact that positive
outcomes are still possible in a context
in which some negative reactions or
feelings on the part of the patients may
occur for example someone may react
negatively to test results but through
your interactions with them ultimately
be able to move forward with a medical
workup which would represent a positive
outcome next let's talk about scripting
at this point you've already
administered the assessment tool and
have scored the instrument regardless of
a passing or a failing score explain the
patient's test result first by reminding
them of the assessment purpose for
example the purpose of this task was to
check on the health of the brain and
determine if there is any need for further
evaluation of your memory the script is
easiest for patients receiving a passing
score for example you obtained a normal
score on this measure which is good news
no additional action is needed in some
cases a caveat may be helpful for
example however if you have concerns
about your thinking or memory talk to or
contact your doctor this is important
because we know that some patients with
real cognitive impairment can pass
simple assessment tools in the office of
course if they are having concerns about
their memory or a family member as
noticing changes in their thinking
behavior or function it's always
important to talk to a doctor
let's review now sample scripting for
patients who fail these cognitive
assessment tools if you are a nurse or
an allied health professional working
inside a clinic your process may be as
simple as deferring to the doctor to
reveal and discuss test results in that
case your script may be something like
your doctor will review the results with
you today
during your visit if you're a physician
or provider your script will be a little
bit different in the case of a patient
failing a cognitive assessment tool you
might say your score on the measure was
a little low today I would like you to
schedule a follow-up appointment with me
or neurology the memory clinic
psychiatry or the appropriate entity on
your way out so we can take a closer
look at your memory this is an important
part of your care an important part of
staying healthy and then of course you
would move forward with entering the
order for that follow-up and referral if
you are an allied health professional a
nurse or social worker for example
working outside the clinic your
scripting will be a little bit different
for example your score on the measure
was a little bit low today this means it
would be good to contact your doctor so
that he or she can be proactive and take
a closer look at how you are doing in
some cases it may be good to provide
additional rationale for example there
are many reasons why someone might
receive a low score a person might be
tired have a
on their mind feel stressed or be
distracted in other cases they might be
taking medications have a shortage of
certain vitamins or nutrients or have a
medical condition that is causing memory
loss contacting your doctor is important
so potential problems can be identified
as early as possible this is a vital
part of staying healthy another option
in explaining a failing score to a
patient or family member is to talk
about the assessment results just like
you would any other medical test so for
example when we do lab tests and they do
not come out as we expect we typically
do a follow-up evaluation or order other
specific tests to help us understand
what may be going on from a medical
perspective if that type of explanation
resonates with you you can say something
to the patient's such as today we did a
brief exam to check on the health of the
brain your score on this measure was a
little low this is like getting blood
work back that is outside the normal
range we should follow up on this I'm
going to send you to a specialist so we
can determine what this means and what
we should do about it in addition to
using these sample scripts to reveal the
test results to patients it is also
helpful to use the assessment process as
an opportunity to discuss memory issues
openly and directly with patients and to
work from their perspective for example
asking individuals are you having any
trouble with your memory or thinking if
yes what do you think might be causing
this or have you talked with anyone
about it have you talked with your
doctor about this if so what happened
this can be helpful not only in
gathering more information about how the
patient is doing but also engaging their
level of insight or readiness to act if
a patient does not do well on a
cognitive assessment and you're
recommending follow up with their doctor
the care coordination then involves
helping to facilitate that appointment
as much as the client and family will
allow or as much as you are able to
within the scope of your role the more
you can do of course the more likely
follow-up will occur in coordinating
care for patients after a cognitive
assessment
it's helpful to promote positive and
health-focused messages again for
example trying to stay away from terms
such as dementia or Alzheimer's disease
and instead focusing on prevention and
wellness encourage involvement of family
members if possible ideally family
members should accompany the patient to
their doctor and participate in the
visit if possible you can also encourage
family members to write down their
observations regarding cognitive
behavioral or functional changes that
they've noticed and put those in bullet
point style on a piece of paper and hand
that to the doctor during the
appointment ultimately in coordinating
care it's also helpful to close the loop
on this issue by saying to patients and
family something like I would like to
see your talk with you again after your
Follow up with the doctor does that sound
reasonable to you in addition to
providing verbal feedback to patients
and families regarding their test
results and next step you may also want
to consider providing written
documentation sample letters are
available for download at the act on
Alzheimer's website at the same page in
which you access this webinar of course
you should follow your organization's
existing HIPAA guidelines when it comes
to providing this documentation either
to patients or health care providers
this is a letter that can be given to
clients to help them understand their
test results and to emphasize next steps
the first paragraph provides brief
rationale for why the cognitive
assessment was administered the second
paragraph emphasizes reasons why an
individual score might be lower than
expected the third paragraph focuses on
brain health wellness and prevention
while the last paragraph emphasizes the
need to contact their doctor to get a
memory checkup the next letter is one
that can be given to providers in the
first paragraph you're just explaining
to the doctor who you are and what your
role is the second paragraph highlights
the fact that your client obtained an
abnormal score on the assessment
instrument the bullet points underneath
are an opportunity to highlight aspects
of the test on which the patient
struggled in
order to emphasize the need for
follow-up the third paragraph simply
underscores the fact that many patients
who do not pass these tests go on to
receive a diagnosis of mild cognitive
impairment Alzheimer's disease or
related dementia after a workup lastly
you are asking the clinic to take action
by having a member of the physician team
contact your client to set up a memory
loss workup instead of using a letter
format to communicate with doctors or
health care providers you can consider
using this checkbox form as another
option the front page offers directions
for using the form of course you should
check to make sure that the form
complies with your organization's
policies concerning HIPPA and as always
you can modify the form as needed to
best fit your needs goals and the
guidelines of your agency you should
fold the page in half at the dotted line
because the information below the dotted
line is written in language appropriate
for health care providers and is not
intended for clients to read or to fill
out make sure that you give clients time
enough to read the paragraph at the top
of the page and answer any questions
that they may have about sharing their
assessment results then ask them to fill
out the form and sign it at the very top
you'll see a short paragraph that
explains to the client the purpose of
this form I give my permission for name
of the agency to send my results from
today's health assessment to my
physician this information will include
my name date of birth phone number and
my assessment results I understand that
sharing this information is intended to
coordinate my care they would then
fill out their name date of birth phone
number the name of their physician the
clinic phone number if known and then
sign and date the form below that you
can see that there's an opportunity for
you to check which detection tool was
used to input the patient's score and
circle whether they passed or failed the
assessment there's also a section for
notes where you can include your own
observations about the individual or
observations from family members or
other pertinent information at the very
bottom there are three
options to check off the first is again
asking the clinic to take action by
contacting your client to help set up a
memory loss workup the second box is
again emphasizing that many patients
with abnormal test results go on to
receive a diagnosis of mild cognitive
impairment or dementia if you choose to
attach a copy of the actual assessment
tool that you've used you can also check
the third box if you decide to use these
letters to communicate with physicians
and Clinics know that health systems
have to cope with a large volume of
paperwork and sometimes letters do get
lost you might want to encourage
patients or family members to bring a
copy of the letter to their doctor
appointment and ultimately you may find
that in some circumstances you have to
fax or mail the provider letter to the
clinic more than once
finally let's cover common questions
that come up from patients after
cognitive assessment and potential
responses understandably many patients
will have questions about what a memory
workup entails as they have not had
experience with this in the past so you
might receive a question such as what
will the doctor do when I see him or her
in that case use simple language to
briefly explain what the workup entails
something like he or she will work with
you to decide what additional tests or
follow-up care is needed to address this
issue and keep you well sometimes a
workup involves answering questions
about your health history including any
observations that you might have about
your memory or thinking
reviewing your medications performing
blood tests to see if you have a
shortage of certain vitamins or
nutrients in your body that could be
causing changes in your memory or
thinking and possibly completing an
x-ray of your head so the doctor can
take a closer look at how your brain is
doing some patients may respond to the
process of cognitive assessment with
questions such as do you think I have
dementia or Alzheimer's disease in that
case the recommended response is to let
them know that the tool that was used
does not tell us what is causing a
person's memory difficulties and cannot
be used to diagnose dementia or
Alzheimer's disease of course there are
many reasons why someone might be
experiencing trouble with their memory
they may not be getting adequate sleep
at night might be under a lot of stress
or feel depressed and other causes
include medication side effects medical
problems like an infection in the body
and vitamin deficiencies not all memory
problems are caused by Alzheimer's but
it's important to see a doctor so we can
identify the cause and find out what if
any treatment might be needed another
possible response is something like my
family complains about my memory but I
do not have a problem everyone my age is
a little forgetful you can respond to
this type of reaction by saying
something like you will write that a lot
of people do experience memory changes
as they get older how much varies from
person to person we all want to stay as
healthy as possible and maintain our
independence for as long as possible
having a brain checkup is another part
of staying healthy and for those who are
worried about the follow-up you might
say something like and might be a good
way to show your family there is nothing
wrong with you or to put this issue to
rest once and for all
a related response might be something
like I think I'm doing fine why should I
see a doctor you might respond by saying
something like it is important to check
the health of the brain as we get older
just like we routinely check on the
health of other organs such as the heart
sometimes memory difficulties can be
reversed with treatment in other cases
early diagnosis of a problem offers the
best chance to treat symptoms and stay
well.