Helder in Gesprek Gives Patients With Cognitive Complaints More Control in the Visit
In memory clinics and geriatrics settings, a consultation can move quickly past the concerns that matter most to people living with cognitive complaints. The Helder in Gesprek tool, or HiG, was designed to interrupt that pattern by helping patients identify topics they want to raise and prepare for the appointment at home through topic cards. In a Dutch feasibility study, the concept did what it was meant to do: it helped participants bring forward their own agenda and gave clinicians a clearer view of the person behind the symptoms.
The intervention was not built to replace clinical judgment or cognitive assessment. Its purpose was narrower and more practical—supporting person-centred communication when memory problems, uncertainty, and consultation time can make priorities easy to miss.
Consultation Content Shifted Toward What Patients Wanted to Say
Seven clinicians recruited ten people with cognitive complaints who had a scheduled visit, along with seven care partners. Observations were completed during 12 consultations, and the study also included questionnaires and interviews with people with cognitive complaints and clinicians. Audio-recorded consultations and interviews were coded inductively and then thematically analysed, allowing the investigators to look beyond whether the tool was liked and into how it actually changed the clinical encounter.
A total of 14 of the 21 topic cards were discussed during consultations. That is a meaningful signal in a feasibility setting because it shows the tool was not simply handled as a symbolic accessory. The cards entered the conversation and gave structure to topics that might otherwise have remained vague, postponed, or omitted altogether. In a field where diagnostic visits can revolve around test results, symptom review, and next steps, the act of setting the agenda becomes clinically relevant. Patients were not only talking more; they were talking about what they had already identified as important.
One sentence captures the intervention’s effect: HiG shifted the consultation toward patient-defined priorities.
Feasibility Was Strong, but the Workflow Still Needs Refinement
Participants generally found HiG acceptable and usable. People with cognitive complaints reported that the tool helped them discuss issues they considered important and made them feel seen as a person rather than reduced to a cognitive diagnosis. Clinicians, in turn, said the tool helped them know patients better. That matters in memory care, where subtle information about daily function, worries, relationships, and expectations often shapes care more than a brief cognitive score alone.
The quantitative ratings support that impression. Participants were likely to recommend HiG to others, with a mean score of 7.9 ± 1.6. Even in a small feasibility sample, that level of endorsement suggests the tool landed as more than a novelty. It was understandable, socially acceptable, and useful enough that users saw value in it for other patients facing similar visits.
Still, implementation questions emerged early. Some participants found card sorting complex, which points to an important design issue: a communication aid can only work if it remains cognitively manageable for the population it is meant to serve. If the preparatory step becomes too demanding, the tool risks losing exactly the people who need the most help organizing a visit. Participants also expressed uncertainty about the best point in the patient journey to introduce the tool. In practice, timing affects uptake, preparedness, and how much of the visit remains available for discussion after orientation, testing, and routine medical review.
Why the Tool Fits the Logic of Memory Care
The rationale behind HiG is clinically intuitive. Cognitive complaints often bring uncertainty about diagnosis, prognosis, function, safety, and the social consequences of decline. A structured set of topic cards can externalize concerns that may be difficult to retrieve spontaneously in the exam room, especially when anxiety, memory impairment, or power imbalance makes self-advocacy harder. By putting topics in front of the patient before the visit, the tool creates a bridge between home reflection and the consultation itself.
This kind of agenda-setting support may be especially valuable in outpatient care, where multiple competing demands can compress the conversation. Clinicians often need to gather symptoms, assess cognition, review medications, and discuss support needs in a limited window. A person-centred tool does not eliminate those obligations. It does, however, help prioritize the human questions that often determine whether a patient feels heard and whether the plan is realistic.
The feasibility study also suggests a broader bedside consequence: when patients are given a structured way to express concerns, clinicians may uncover issues that would otherwise stay hidden. In memory care, that can include fear, family strain, confusion about follow-up, or doubts about what symptoms mean. Those are not peripheral details. They shape adherence, trust, and willingness to return for care.
What Feasibility Can and Cannot Prove
The study establishes feasibility, not effectiveness. It shows that HiG can be used in outpatient settings, that patients and clinicians can accept it, and that it can enter the consultation in a way that affects dialogue. It does not yet show whether the tool changes downstream outcomes such as symptom burden, decisional quality, care planning, caregiver strain, or continuity of follow-up.
The sample was also small, involving seven clinicians, ten people with cognitive complaints, and seven care partners. Observations across 12 consultations provide rich qualitative insight, but they cannot settle questions about generalizability across clinics, staffing models, or patient populations with different levels of cognitive impairment. The findings do, however, identify the next implementation hurdles with unusual clarity: simplify the card-sorting process, determine when in the care pathway the tool should be introduced, and test whether the intervention remains workable when scaled beyond a tightly observed feasibility study.
For now, HiG stands as a communication aid that helped people with cognitive complaints prepare, speak, and be heard. The next step is to determine whether that improved conversation translates into measurable gains in outpatient dementia and geriatric care.