Search

Among health professionals, there is wide variation in the practice of disclosing a diagnosis of dementia to patients. The purpose of this study was to evaluate the effect of one theory-based and two pragmatic interventions on intention to perform three behaviors, namely (1) finding out what the patient already knows or suspects about their diagnosis; (2) using the actual words “dementia” or “Alzheimer’s disease” when talking to the patient (i.e., the use of explicit terminology); (3) exploring what the diagnosis means to the patient. Within an intervention-modeling process, members of old-age mental health teams in England were sent postal questionnaires measuring psychological variables. Respondents were randomized by team to one of four groups to receive: theory-based intervention; evidence-based communication; patient-based intervention; or no intervention (control). Interventions were delivered as pen-and-paper exercises at the start of a second postal questionnaire that remeasured the same psychological variables. The outcome measures were intention and scenario-based behavioral simulation. Responses were received from 644 of 1,103 (58%) individuals from 179 of 205 (87%) mental health teams. There were no significant differences in terms of intention or simulated behavior between the trial groups. The theory-based intervention significantly increased scores for attitudes to ( p = 0.03) and perceived behavioral control ( p = 0.001) for the behavior of “finding out what the patient already knows or suspects about their diagnosis.” The intervention had a limited effect. This may be partly explained by clinical or methodological factors. The use of a systematic intervention modeling process allows clearer understanding of the next appropriate steps which should involve further evaluation of the interventions using an interactive delivery method in a less selected group of study participants. [ABSTRACT FROM AUTHOR]

Background: Despite growing evidence that many people with dementia want to know their diagnosis, there is wide variation in attitudes of professionals towards disclosure. The disclosure of the diagnosis of dementia is increasingly recognised as being a process rather than a one-off behaviour. However, the different behaviours that contribute to this process have not been comprehensively defined. No intervention studies to improve diagnostic disclosure in dementia have been reported to date. As part of a larger study to develop an intervention to promote appropriate disclosure, we sought to identify important disclosure behaviours and explore whether supplementing a literature review with other methods would result in the identification of new behaviours. Methods: To identify a comprehensive list of behaviours in disclosure we conducted a literature review, interviewed people with dementia and informal carers, and used a consensus process involving health and social care professionals. Content analysis of the full list of behaviours was carried out. Results: Interviews were conducted with four people with dementia and six informal carers. Eight health and social care professionals took part in the consensus panel. From the interviews, consensus panel and literature review 220 behaviours were elicited, with 109 behaviours over-lapping. The interviews and consensus panel elicited 27 behaviours supplementary to the review. Those from the interviews appeared to be self-evident but highlighted deficiencies in current practice and from the panel focused largely on balancing the needs of people with dementia and family members. Behaviours were grouped into eight categories: preparing for disclosure; integrating family members; exploring the patient's perspective; disclosing the diagnosis; responding to patient reactions; focusing on quality of life and well-being; planning for the future; and communicating effectively. Conclusion: This exercise has highlighted the complexity of the process of disclosing a diagnosis of dementia in an appropriate manner. It confirms that many of the behaviours identified in the literature (often based on professional opinion rather than empirical evidence) also resonate with people with dementia and informal carers. The presence of contradictory behaviours emphasises the need to tailor the process of disclosure to individual patients and carers. Our combined methods may be relevant to other efforts to identify and define complex clinical practices for further study. [ABSTRACT FROM AUTHOR]

Background: For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs) to perform key behaviours involved in the disclosure of dementia. Design: Postal questionnaire survey. Participants: Professionals from MHTs in the English National Health Service. Methods: We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), and exploratory team variables. Main outcomes: Behavioural intentions. Results: Out of 1,269 professionals working in 85 MHTs, 399 (31.4%) returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4% of the variance in intention. For the use of explicit terminology, the same variables explained 53.7% of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6% of intention. Conclusion: These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically-supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors. [ABSTRACT FROM AUTHOR]