Cognitive Management Pathways in Stroke Services (COMPASS): A qualitative investigation of key issues in relation to community stroke teams undertaking cognitive assessments:

Introduction Cognitive problems are common after stroke and their identification and management is important for survivors, carers and clinicians. However, the appropriateness of the screening methods and ways in which results inform community clinical care have not been established. The aim of this phase of the Cognitive Management Pathways in Stroke Services study was to explore key issues to undertaking cognitive assessment, particularly in community settings. Method Participants recruited via local and national contacts, and from an earlier phase of the Cognitive Management Pathways in Stroke Services research, took part in face-to-face or telephone semi-structured interviews. Data were analysed using framework analysis. Findings: Twenty-one occupational therapists were recruited. Availability of cognitive tests, personal knowledge, previous experience, training, cost, time and familiarity were key factors in conducting cognitive screening assessments and interpreting results. Other factors included patient language or mood deficits, the assessment environment, lack of experience, confidence and workload. Conclusion There is variation in the cognitive screening of stroke survivors in the community. Screening assessments are being used by occupational therapists based on availability and familiarity, rather than evidence of their validity and sensitivity. There is also variation in the interpretation of such assessments, which has implications for clinical practice.