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Challenges in disclosing and receiving a diagnosis of dementia: a systematic review of practice from the perspectives of people with dementia, carers, and healthcare professionals. Int Psychogeriatr 2021; 33:1161-1192. [PMID: 33726880 DOI: 10.1017/s1041610221000119] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disclosing a diagnosis of dementia is a key process involving people with dementia, carers, and healthcare professionals (HCPs) that can facilitate access to treatment and support. Receiving a diagnosis of dementia may represent a change in identity and loss of a planned-for future, resulting in an emotional impact for both people with dementia and carers. Delivering the diagnosis of dementia can be difficult and draining for HCPs. METHODS We conducted a systematic review that included studies which explored the experience of giving or receiving a diagnosis of dementia from the perspectives of people with dementia, carers, or HCPs. All study designs were eligible except for previous literature reviews. Findings were analyzed thematically and grouped into categories and then synthesized into a narrative review. The quality of all included studies was assessed. RESULTS Fifty-two studies were included in this review. Findings indicated that receiving a diagnosis is generally a negative process for people with dementia, carers, and HCPs and leaves carers in particular feeling uncertain over the prognosis and future of the person they care for. Disclosing a diagnosis of dementia is a difficult and complex process, for which formal training and guidance is lacking. Carers in particular would welcome more opportunity for realistic and hopeful discussions of the implications of receiving a diagnosis of dementia. CONCLUSIONS Changes in some aspects of disclosure, such as providing a truthful diagnosis to the person with dementia, have occurred over the last decade. A process approach involving pre-diagnostic counseling and follow-up appointments could enable discussions regarding prognosis and the future, create opportunities to clarify the diagnosis, and reduce emotional burden on HCPs. There is a need for more objective evidence that considers the perspectives of all individuals involved.
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Breuer E, Freeman E, Alladi S, Breedt M, Govia I, López-Ortega M, Musyimi C, Oliveira D, Pattabiraman M, Sani TP, Schneider M, Swaffer K, Taylor D, Taylor E, Comas-Herrera A. Active inclusion of people living with dementia in planning for dementia care and services in low- and middle-income countries. DEMENTIA 2021; 21:380-395. [PMID: 34468232 DOI: 10.1177/14713012211041426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Involving people living with dementia in service design and planning has become more common in high-income countries. It remains rare in low- and middle-income countries where two-thirds of the world's people with dementia live. In this commentary article, we explore the barriers to inclusion of people living with dementia in planning in low- and middle-income countries and make a case for the inclusion of people living with dementia in care and service planning. We suggest how this can be done at individual, community or national and state level using the following principles: 1) respecting the rights of people living with dementia to self-determination; 2) valuing people living with dementia's unique understanding of dementia; 3) creating a culture of active inclusion which creates a space for people living with dementia to participate and 4) ensuring appropriate accommodations are in place to maximise participation.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Emily Freeman
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
| | - Suvarna Alladi
- Department of Neurology, 29148National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Marinda Breedt
- STRiDE South Africa National Advisory Group, Cape Town, South Africa
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, 54657The University of the West Indies, Kingston, Jamaica
| | | | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Déborah Oliveira
- Department of Psychiatry, 28105Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | - Tara Puspitarini Sani
- 64732Alzheimer Indonesia and Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, 37716University of Cape Town, Rondebosch, South Africa
| | - Kate Swaffer
- Dementia Alliance International and Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, NSW, Australia
| | - Dubhglas Taylor
- Dementia Alliance International and Dementia Awareness Advocacy Team, Capalaba, QLD, Australia
| | - Eileen Taylor
- Dementia Alliance International and Dementia Awareness Advocacy Team, Brisbane, QLD, Australia
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
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Peixoto VGDMNP, Diniz RVZ, Godeiro CDO. SPIKES-D: a proposal to adapt the SPIKES protocol to deliver the diagnosis of dementia. Dement Neuropsychol 2020; 14:333-339. [PMID: 33354284 PMCID: PMC7735056 DOI: 10.1590/1980-57642020dn14-040001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dementia is a life-threatening and stigmatizing condition, with devastating impacts on the patient's personal identity and caregivers. There are many barriers to an effective diagnosis disclosure of dementia, including fear of causing distress, uncertainty of diagnosis, caregivers' objection and lack of training in communication skills in undergraduate medical schools. Although some studies have been published on how to help physicians deliver an Alzheimer's disease diagnosis, no specific protocol has been published yet. The SPIKES protocol is a didactic approach designed to deliver bad news related to cancer, but it has been used globally and in a variety of clinical settings, including the teaching of communication skills to medical students and residents. It is known, however, that the cognitive impairment of Alzheimer's disease and other dementias may limit the understanding of the diagnosis' complexity; hence, a few adaptations of this model were made after reviewing the current literature on dementia diagnosis disclosure. The suggested SPIKES-D protocol seems to encompass current guidelines about the communication of the diagnosis of dementia, keeping its didactic approach on breaking bad news and helping fulfill the gaps in this topic.
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Calil V, Elliott E, Borelli WV, Barbosa BJAP, Bram J, Silva FDO, Cardoso LGM, Mariano LI, Dias N, Hornberger M, Caramelli P. Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop. Dement Neuropsychol 2020; 14:201-208. [PMID: 32973973 PMCID: PMC7500814 DOI: 10.1590/1980-57642020dn14-030001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In July 2019, a group of multidisciplinary dementia researchers from Brazil and
the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil,
to discuss and propose solutions to current challenges faced in the diagnosis,
public perception and care of dementia. Here we summarize the outcomes from the
workshop addressing challenges in diagnosis. Brazil faces a major problem in
dementia underdiagnosis, particularly involving the population in an adverse
socioeconomic context. There is poor availability of resources and specialists,
and the knowledge of general practitioners and other healthcare professionals is
far from satisfactory. Low education level is a further obstacle in diagnosing
dementia, as the most commonly used screening tests are not designed to evaluate
this population. Patients and their families must overcome the stigma of a
diagnosis of dementia, which is still prevalent in Brazil and increases the
burden of this condition. Whilst the UK has greater resources, dedicated memory
services and a National Dementia Strategy plan, the National Health Service
(NHS) has limited funding. Therefore, some challenges regarding diagnosis are
common across both countries. The authors suggest possible solutions to confront
these, with the goal of improving assessment and recognition of dementia and
reducing misdiagnosis.
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Affiliation(s)
- Victor Calil
- Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro, RJ, Brazil.,Universidade Federal do Rio de Janeiro - Rio de Janeiro, RJ, Brazil
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow - Glasgow, United Kingdom
| | - Wyllians Vendramini Borelli
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira - Recife, PE, Brazil.,Departmento de Neurologia, Hospital das Clínicas, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Jessyka Bram
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Natalia Dias
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Michael Hornberger
- Norwich Medical School, University of East Anglia - Norwich, United Kingdom
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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Abstract
BACKGROUND Disclosing the diagnosis of Alzheimer's disease (AD) to a patient is controversial. There is significant stigma associated with a diagnosis of AD or dementia in China, but the attitude of the society toward disclosure of such a diagnosis had not been formally evaluated prior to our study. Therefore, we aimed to evaluate the attitude toward disclosing an AD diagnosis to patients in China with cognitive impairment from their caregivers, and the factors that may affect their attitude. METHODS We designed a 17-item questionnaire and administered this questionnaire to caregivers, who accompanied patients with cognitive impairment or dementia in three major hospitals in Shanghai, China. The caregiver's attitude toward disclosing the diagnosis of AD as evaluated by the questionnaire was compared to that of disclosing the diagnosis of terminal cancer. RESULTS A majority (95.7%) of the 175 interviewed participants (mean 14.2 years of education received) wished to know their own diagnosis if they were diagnosed with AD, and 97.6% preferred the doctor to tell their family members if they were diagnosed with AD. If a family member of the participants suffered from AD, 82.9% preferred to have the diagnosis disclosed to the patient. "Cognitive impairment" was the most accepted term by caregivers to disclose AD diagnosis in Chinese. CONCLUSION This study suggests most of the well-educated individuals in a Chinese urban area favored disclosing the diagnosis when they or their family members were diagnosed with AD.
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Abstract
BACKGROUND Studies in memory clinics suggest that the majority of patients would like to know of a diagnosis of dementia. It is less clear what preferences are in the community. Our objective was to review the literature on preferences regarding disclosure of a diagnosis of dementia and to assess key arguments in favor of and against disclosure. METHODS Systematic search of empirical studies was performed in Pubmed, Embase, and Psycinfo. We extracted preferences of individuals without cognitive impairment (general population; relatives of dementia patients; and physicians) and preferences of individuals referred to a memory clinic or already diagnosed with dementia. A meta-analysis was done using a random effects model. Our main conclusions are based on studies with a response rate ≥75%. RESULTS We included 23 articles (9.065 respondents). In studies with individuals without cognitive impairment, the pooled percentage in favor of disclosure was 90.7% (95%CI: 83.8%-97.5%). In studies with patients who were referred to a memory clinic or already diagnosed with dementia, the pooled percentage that considered disclosure favorable was 84.8% (95%CI: 75.6%-94.0%). The central arguments in favor of disclosure pertained to autonomy and the possibility to plan one's future. Arguments against disclosure were fear of getting upset and that knowing has no use. CONCLUSIONS The vast majority of individuals without and with cognitive impairment prefers to be informed about a diagnosis of dementia for reasons pertaining to autonomy.
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Diagnosis disclosure and advance care planning in Alzheimer disease: opinions of a sample of Italian citizens. Aging Clin Exp Res 2014; 26:427-34. [PMID: 24557811 DOI: 10.1007/s40520-014-0195-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS In current Alzheimer disease (AD) research there is growing asymmetry between the modest benefits of the currently available treatments, in contrast to the possibility to diagnose AD early in its natural history. This complex situation brings along a number of important ethical issues about diagnosis disclosure and end-of-life decisions that need to be addressed. The principal aim of the study was to investigate the attitudes towards disclosure of a diagnosis of AD and disposition towards completion of advance care planning, in a sample of Italian citizens. METHODS A convenience sample of 1,111 Italian citizens recruited from a community hospital in Brescia were interviewed using a structured questionnaire with both yes/no and multiple choice format questions about AD. RESULTS The majority of the sample (83 %) wanted disclosure for themselves. Women and caregivers were significantly less likely to agree that their hypothetically afflicted relative should be informed of a diagnosis of AD. The majority of the sample (81 %) was in favor of advance care planning completion, most of all younger participants and non-caregivers. Less than a third of the sample (24 %) was aware of the existence a judicially appointed guardian for patients affected by dementia. CONCLUSION The majority of the participants wanted a potential diagnosis of AD to be disclosed to them and to their relatives if they were to be afflicted. The utility of completion of advance care planning and designation of a judicially appointed guardian is frequently endorsed by the sample.
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Somme D, Gautier A, Pin S, Corvol A. General practitioner's clinical practices, difficulties and educational needs to manage Alzheimer's disease in France: analysis of national telephone-inquiry data. BMC FAMILY PRACTICE 2013; 14:81. [PMID: 23763854 PMCID: PMC3682915 DOI: 10.1186/1471-2296-14-81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 01/24/2023]
Abstract
Background The literature has emphasized the role of general practitioners (GPs) in caring for Alzheimer’s disease (AD) patients. Within the framework of the French national AD plan, an inquiry was undertaken to identify the clinical practices, difficulties and training needs of GPs managing this pathology. Methods A random sample from a representative national listing of continental French GPs following ≥1 AD patients comprised the study population. Participants completed a standard questionnaire on their clinical practices, difficulties and educational needs for AD management. Feeling insufficiently trained was subjected to univariate and multivariate analyses. Results A minority of the 974 respondents declared using questionnaires in their diagnostic evaluation (15.2%), told the patient the diagnosis (8.2%) and was aware of the national recommendations for AD (41.9%). Behavioral disorders represented the most common (73.5%) problem encountered, while half of the GPs considered management of comorbidities easy roles to fulfill. In comparison, coordination of care and assistance did not seem to be a primary problem. A score was calculated, attributing 1 point to each of the following items: need for further education in terms of communications with the family, with patients, disclosing the diagnosis, and non-drug treatments. The factors linked to feeling insufficiently trained for 3 or 4 of the 4 items were: female sex; not involved in educational programs (for parents/family and patients) and no activity related to training medical students. Conclusions Our study identified gaps in French GP training concerning AD diagnosis practices and diagnosis announcement. GPs seemed aware of their educational needs and described difficulties in managing behavioral disorders. Our findings enabled the definition of policy priorities to provide training and disseminate information.
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Abstract
BACKGROUND Consensus recommends early recognition of memory problems through multi-disciplinary assessment in memory clinics; however, little is known about the experiences of people accessing such services. The aim of this review was to synthesis empirical evidence on patient and carer experiences in the transition to dementia. METHODS This review updates an earlier review (Bamford et al., 2004) on the topic of disclosure of the diagnosis of dementia. Key electronic databases were searched including OVID Medline, CINAHL, Web of Science, EMBASE, and Sociological Abstracts; this was supplemented by hand searching of reference lists and contact with experts in the field. Only papers published after 2003 were included. RESULTS Of the 35 papers included in the review, only one study observed the process of disclosure and only two papers explored the effects on the person with dementia's health. The vast majority of people with dementia wished to know their diagnosis. The key challenges for the person with dementia were coming to terms with losses on multiple levels. Although there may be short-term distress, the majority of people with dementia do not appear to experience long-term negative effects on their psychological health. For family carers, becoming the main decision-maker and adjusting to increased responsibility were common concerns. CONCLUSIONS There is still little empirical research observing the process of diagnostic disclosure in dementia. Studies exploring the views of patients and their families suggest this should be an ongoing process with the provision of support and information tailored to individual needs. The term "Alzheimer's disease" appears to have more negative connotations than the word "dementia".
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Frota NAF, Nitrini R, Damasceno BP, Forlenza OV, Dias-Tosta E, da Silva AB, Herrera Junior E, Magaldi RM. Criteria for the diagnosis of Alzheimer's disease: Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2011; 5:146-152. [PMID: 29213739 PMCID: PMC5619474 DOI: 10.1590/s1980-57642011dn05030002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/17/2011] [Indexed: 11/22/2022] Open
Abstract
This consensus prepared by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology is aimed at recommending new criteria for the diagnosis of dementia and Alzheimer's disease (AD) in Brazil. A revision was performed of the proposals of clinical and of research criteria suggested by other institutions and international consensuses. The new proposal for the diagnosis of dementia does not necessarily require memory impairment if the cognitive or behavioral compromise affects at least two of the following domains: memory, executive function, speech, visual-spatial ability and change in personality. For the purpose of diagnosis, AD is divided into three phases: dementia, mild cognitive impairment and pre-clinical phase, where the latter only applies to clinical research. In the dementia picture, other initial forms were accepted which do not involve amnesia and require a neuroimaging examination. Cerebrospinal fluid biomarkers are recommended for study, but can be utilized as optional instruments, when deemed appropriate by the clinician.
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Affiliation(s)
- Norberto Anízio Ferreira Frota
- Medicine Course, University of Fortaleza (Unifor). Neurology Service of Fortaleza General Hospital (HGF), Fortaleza CE, Brazil
| | - Ricardo Nitrini
- Cognitive Neurology and Behavior Group, Hospital das Clínicas, School of Medicine, University of São Paulo (FMUSP). Referral Center for Cognitive Disorders (CEREDIC) of the FMUSP, São Paulo SP, Brazil
| | | | - Orestes V Forlenza
- Neurosciences Laboratory-LIM 27, Department and Institute of Psychiatry, School of Medicine, FMUSP
| | - Elza Dias-Tosta
- Neurologist, Hospital de Base, Federal District, Brasília DF, Brazil
| | | | - Emílio Herrera Junior
- Department of Internal Medicine, School of Medicine of Catanduva, Catanduva SP, Brazil
| | - Regina Miksian Magaldi
- Geriatrics Service, Hospital das Clínicas, FMUSP and Referral Center for Cognitive Disorders, Hospital das Clínicas, FMUSP, São Paulo SP, Brazil
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