New fitness-to-drive test could streamline process for GPs

GPs face numerous challenges in their daily practice – and among them is having to inform a patient that they are unfit to drive.
 
The emotional toll can be so severe that GPs have reported losing sleep over it.
 
That’s according to Dr Theresa Scott, a Senior Lecturer in Clinical Geropsychology at the University of Queensland, who has conducted research on the matter.
 
‘GPs were telling me this is something that keeps them up at night,’ Dr Scott told newsGP.
 
‘They understand the impact that having to tell someone they should no longer drive has on the doctor–patient relationship – but they see themselves as advocates for their patients. So that is a major hurdle.’
 
What often compounds the challenge, Dr Scott says, are flaws in current driving tests, with GPs often having to resort to memory tests, which can make it difficult for patients to accept the outcome when they fail to see a direct correlation between their dementia and the impact on their driving skills.
 
In other cases, Dr Scott says people living with dementia are given no formal assessment, or are advised they have to stop driving as soon as they are diagnosed, even when they could continue driving safely.
 
But there are hopes a new online assessment tool will be the first reliable and valid test to assist GPs and streamline the process.
 
Led by Dr Scott, a team of researchers are currently developing the tool with input from both people living with dementia and GPs themselves.
 
Based on the hazard perception test used as part of the Queensland Government’s driver licencing system, the patient will either sit the test at a computer screen or on a large tablet, and look at real on-road video footage from the driver’s perspective. They will then be asked to identify potentially dangerous situations by either clicking on a mouse or verbalising it.
 
While the test is still being refined, Dr Scott anticipates it will take between 10–15 minutes to complete.
 
‘We recognise that this is going to be delivered in a primary care practice, so it needs to be reasonably brief but still valid,’ she said.
 
‘We expect that perhaps a practice nurse might implement the tests in those practices where there are practice nurses, and then the results of that test would be something that the GP then discusses with the patient.’
 
UQ Faculty of Medicine’s Emeritus Professor Geoff Mitchell, who is a practising GP, said the tool is practical and reliable, and will be welcomed by all GPs who look after people with dementia.
 
‘Current office assessments conducted by GPs are fraught with risk, but the fitness-to-drive tool will mean GPs won’t have to rely on paper and pencil tests that have no association with on-road driving ability,’ he said.
 
‘Currently the tools available are blunt instruments, and GPs heavily rely on memory tests and opinions of loved ones.’
 
Professor Mitchell believes it will also ‘reduce the risk of fractured relationships with patients’ when refusal to grant a licence occurs or GPs have to refer the person for further testing.
 
Dr Scott agrees, and says it will go a long way towards helping patients to understand the direct impact of their dementia on their driving, and hopefully assist in the transition, which is often a significant lifestyle change.
 
‘I’ve even talked to people who become suicidal once they’re told that they can’t drive because of the effect on their independence, but also on their identity,’ she said.
 
‘There will still be some difficulties with some people, I’m sure, but we believe that it will be more acceptable to people who are living with dementia because they’ll be able to see there’s some relationship to their ability to predict dangerous situations, for example, to their own road driving abilities.’
 
The ‘Navigating Fitness to Drive with Patients with Dementia’ project has been awarded $1.3 million under the Federal Government’s Medical Research Future Fund, and is expected to be available for use in clinical practice nationally by 2025.
 
There are approximately 472,000 Australians living with dementia.
 
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