"I Wish We Could Normalize Driving Health:" A Qualitative Study of Clinician Discussions with Older Drivers

BACKGROUND: Driving for older adults is a matter of balancing independence, safety and mobility, and prematurely relinquishing the car keys can impact morbidity and mortality. Discussions about "when to hang up the keys" are difficult for clinicians, drivers, and family members, and therefore are often avoided or delayed. "Advance Driving Directives" (ADDs) may facilitate conversations between health care providers and older drivers focused on prevention and advance planning for driving cessation. To examine clinician and older driver perspectives on ADDs and driving discussions. Qualitative descriptive study using iterative focus groups and interviews with clinicians and drivers. (1) Eight practicing internal medicine physicians, physician assistants or nurse practitioners working at three university-affiliated clinics; and (2) 33 community-dwelling current drivers aged 65 years or older. Theme analysis of semi-structured focus groups and interviews with clinicians and older drivers was used to explore clinician and driver perspectives on "ADDs" and driving conversations. General inductive qualitative techniques were used to identify barriers and facilitators to conversations between older drivers and their healthcare providers about driving and health. Five dominant themes emerged: (1) clinicians usually initiate conversations, but typically not until there are "red flags;" (2) drivers are open to conversations, especially if focused on prevention rather than interventions; (3) family input influences clinicians and drivers; (4) clinical setting factors like short appointments affect conversations; and (5) both clinicians and drivers thought ADDs could be useful in some situations and recommended making general questions about driving a part of routine care. Clinicians and older drivers often wait to discuss driving until there are specific "red flags", but both groups support a new framework in which physicians routinely and regularly bring up driving with patients earlier in order to facilitate planning for the future.