A qualitative study investigating clinician experiences with lecanemab implementation across seven academic medical centers

Abstract

Background

The recent approval of anti-amyloid therapies (AATs) for Alzheimer's disease (AD) has introduced new complexities into clinical care. While offering therapeutic promise, AATs necessitate changes in practice models, infrastructure, and team responsibilities. Understanding clinician and system-level adaptations is critical to guide implementation.

Objective

To explore how clinicians adjust clinical workflows and care processes when integrating anti-amyloid treatments into AD management.

Methods

We conducted semi-structured interviews with neurology and geriatrics clinicians across seven academic medical centers to explore perspectives on AAT implementation. An interdisciplinary team used hybrid deductive-inductive coding and thematic analysis to identify themes.

Results

Twenty-seven clinicians (17 neurology, 10 geriatrics) participated. Three themes emerged: (1) Structural adaptations: Sites developed governance committees, eligibility protocols, and workflows for referrals, administration, and monitoring. Some hired new staff, and protocols evolved with experience. (2) Diagnostic shifts: Clinicians reported heightened pressure for earlier, more precise diagnoses, prompting greater biomarker use and structured disclosure visits incorporating treatment discussions. (3) Cultural change: While clinicians described optimism about disease-modifying therapies, they expressed ethical concerns about resource allocation, over-medicalization of early dementia, and diversion of resources from broader dementia care.

Conclusions

The findings reflect evolving institutional protocols, clinical roles and responsibilities, and ethical tensions within the clinical workforce in response to AAT administration and access to early diagnosis and treatment.