Why to test for dementia: perspectives of patients, significant others and general practitioners

Author:

Linden Iris12ORCID,Wolfs Claire12,Hevink Maud12,Dirksen Carmen34,Ponds Rudolf125,Perry Marieke6787

Affiliation:

1. Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, , Maastricht , The Netherlands

2. Maastricht University , School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, , Maastricht , The Netherlands

3. Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) , Care and Public Health Research Institute (CAPHRI), , Maastricht , The Netherlands

4. Maastricht University Medical Centre , Care and Public Health Research Institute (CAPHRI), , Maastricht , The Netherlands

5. Department of Medical Psychology, Amsterdam University Medical Center , VU, Amsterdam , The Netherlands

6. Department of Geriatric Medicine , Radboudumc Alzheimer Center, , Nijmegen , The Netherlands

7. Radboud University Medical Center , Radboudumc Alzheimer Center, , Nijmegen , The Netherlands

8. Department of Primary and Community Care , Radboudumc Alzheimer Center, , Nijmegen , The Netherlands

Abstract

Abstract Background This study aims to provide greater insight into the current decision-making process on diagnostic testing for dementia by exploring the expectations, needs and experiences of patients with memory complaints, significant others and general practitioners (GPs). Methods We performed semi-structured interviews with patients (>60 years) who consulted their GP on memory complaints, significant others and GPs. Participants were recruited until data saturation was reached in thematic analysis of interview transcripts. Results We performed 51 interviews (patients n = 20, significant others n = 15, GPs n = 16). Thematic analysis revealed four themes: (i) ‘drivers to (not) testing’, i.e. need to act on symptoms, beliefs on the necessity and expected outcomes of diagnostic testing; (ii) ‘patient preferences and context are critical in the actual decision’, i.e. in the actual decision-making process interpretation of symptoms, GPs’ desire to meet patient preferences, social context and healthcare system dynamics guided the decision; (iii) ‘need for individualised communication in the decision-making process’, i.e. for patients feeling heard was a prerequisite for decision-making and GPs tailored communication strategies to individual patients and (iv) ‘GP practice and barriers to shared decision-making (SDM)’, i.e. although GPs value SDM in the decision on diagnostic testing for dementia, patients express limited awareness of the decision and options at stake. Conclusions Decision-making on diagnostic testing for dementia is a multifactorial and preference-guided process for all involved stakeholders, but decisions are often not explicitly jointly made. Development of patient decision aids could facilitate better involvement and more informed choices by patients.

Funder

ZonMw

Publisher

Oxford University Press (OUP)

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