Communication and shared decision‐making for anti‐amyloid therapy in early Alzheimer's disease: An exploratory qualitative study of real‐world audio‐recorded clinical encounters
7 affiliations
- 1Mongan Institute Center for Optimal Aging and Serious Illness Massachusetts General Hospital Boston Massachusetts USA
- 2Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital Boston Massachusetts USA
- 3Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania USA
- 4Division of Cognitive and Behavioral Neurology Brigham and Women's Hospital Boston Massachusetts USA
- 5Memory Disorders Division, Department of Neurology Massachusetts General Hospital Boston Massachusetts USA
- 6Department of Neurology Brigham and Women's Hospital Boston Massachusetts USA
- 7Division of General Internal Medicine Massachusetts General Hospital Boston Massachusetts USA
Abstract
INTRODUCTION: Anti‐amyloid therapies (AATs) for Alzheimer's disease (AD) offer modest slowing of cognitive decline but involve meaningful risks, burdens, and uncertainty. Decisions about AAT are preference sensitive and optimally guided by shared decision making (SDM), yet little is known about how these conversations unfold in real‐world clinical practice.
METHODS: We conducted an exploratory qualitative content analysis of audio‐recorded AAT counseling encounters in neurology clinics at two academic medical centers. Participants included neurology clinicians, patients with mild cognitive impairment or mild dementia due to AD, and care partners. We examined how clinicians presented options, benefits, risks, and burdens; elicited patient values and preferences; assessed understanding; and engaged patients and care partners.
RESULTS: We analyzed 10 encounters involving 9 patients and 5 clinicians; 8 patients had a care partner present. Encounters occurred at different stages of decision making, including pre‐decision visits and visits in which a treatment decision was made. Clinicians consistently explained AAT mechanisms using action‐oriented language, emphasized modest benefits, and discussed amyloid‐related imaging abnormalities, magnetic resonance imaging monitoring as a safety net, and treatment logistics. However, communication framing varied. Some clinicians used optimistic framing that may have shaped treatment perceptions, while explicit discussion of not pursuing AAT as a valid option was rare. Open‐ended exploration of values and goals varied and occurred more often in pre‐decision encounters, whereas visits closer to treatment decisions focused on treatment selection and logistics. Assessment of treatment understanding ranged from open‐ended teach‐back, which revealed misunderstandings in some cases, to closed‐ended checks. Clinicians also varied in how they balanced patient and care partner participation.
DISCUSSION: Although clinicians consistently addressed core medical information about AAT, variation in framing, values elicitation, teach‐back, presentation of alternatives, and patient–care partner engagement may shape AAT decision making. Communication strategies that explicitly present options, connect potential outcomes to patient priorities, and reinforce understanding may support balanced, values‐aligned SDM.
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BibTeX
@article{paladino2026communication,
title = {{Communication and shared decision‐making for anti‐amyloid therapy in early Alzheimer's disease: An exploratory qualitative study of real‐world audio‐recorded clinical encounters}},
author = {Joanna Paladino and Haley Echols and Ayush Thacker and Seth A. Gale and Liliana Ramirez Gomez and Emma Weizenbaum and Charles T. Pu and Christine Ritchie and Sachin J. Shah and Elizabeth Lindenberger},
journal = {Alzheimer's \& Dementia : Translational Research \& Clinical Interventions},
year = {2026},
month = oct,
doi = {10.1002/trc2.70343},
url = {https://doi.org/10.1002/trc2.70343},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Communication and shared decision‐making for anti‐amyloid therapy in early Alzheimer's disease: An exploratory qualitative study of real‐world audio‐recorded clinical encounters
AU - Joanna Paladino
AU - Haley Echols
AU - Ayush Thacker
AU - Seth A. Gale
AU - Liliana Ramirez Gomez
AU - Emma Weizenbaum
AU - Charles T. Pu
AU - Christine Ritchie
AU - Sachin J. Shah
AU - Elizabeth Lindenberger
PY - 2026
DA - 2026/10/30
JO - Alzheimer's & Dementia : Translational Research & Clinical Interventions
DO - 10.1002/trc2.70343
UR - https://doi.org/10.1002/trc2.70343
AB - INTRODUCTION: Anti‐amyloid therapies (AATs) for Alzheimer's disease (AD) offer modest slowing of cognitive decline but involve meaningful risks, burdens, and uncertainty. Decisions about AAT are preference sensitive and optimally guided by shared decision making (SDM), yet little is known about how these conversations unfold in real‐world clinical practice. METHODS: We conducted an exploratory qualitative content analysis of audio‐recorded AAT counseling encounters in neurology clinics at two academic medical centers. Participants included neurology clinicians, patients with mild cognitive impairment or mild dementia due to AD, and care partners. We examined how clinicians presented options, benefits, risks, and burdens; elicited patient values and preferences; assessed understanding; and engaged patients and care partners. RESULTS: We analyzed 10 encounters involving 9 patients and 5 clinicians; 8 patients had a care partner present. Encounters occurred at different stages of decision making, including pre‐decision visits and visits in which a treatment decision was made. Clinicians consistently explained AAT mechanisms using action‐oriented language, emphasized modest benefits, and discussed amyloid‐related imaging abnormalities, magnetic resonance imaging monitoring as a safety net, and treatment logistics. However, communication framing varied. Some clinicians used optimistic framing that may have shaped treatment perceptions, while explicit discussion of not pursuing AAT as a valid option was rare. Open‐ended exploration of values and goals varied and occurred more often in pre‐decision encounters, whereas visits closer to treatment decisions focused on treatment selection and logistics. Assessment of treatment understanding ranged from open‐ended teach‐back, which revealed misunderstandings in some cases, to closed‐ended checks. Clinicians also varied in how they balanced patient and care partner participation. DISCUSSION: Although clinicians consistently addressed core medical information about AAT, variation in framing, values elicitation, teach‐back, presentation of alternatives, and patient–care partner engagement may shape AAT decision making. Communication strategies that explicitly present options, connect potential outcomes to patient priorities, and reinforce understanding may support balanced, values‐aligned SDM.
SN - 2352-8737
ER -