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How do doctors deliver a diagnosis of dementia in memory clinics?

Dooley, J., Bass, N. and McCabe, R. ORCID: 0000-0003-2041-7383 (2018). How do doctors deliver a diagnosis of dementia in memory clinics?. The British Journal of Psychiatry, 212(4), pp. 239-245. doi: 10.1192/bjp.2017.64

Abstract

Background
Dementia diagnosis rates are increasing. Guidelines recommend that people with dementia should be told their diagnosis clearly and honestly to facilitate future planning.

Aims
To analyse how doctors deliver a dementia diagnosis in practice.

Method
Conversation analysis was conducted on 81 video-recorded diagnosis feedback meetings with 20 doctors from nine UK memory clinics.

Results
All doctors named dementia; 59% (n = 48) approached the diagnosis indirectly but delicately (‘this is dementia’) and 41% (n = 33) approached this directly but bluntly (‘you have Alzheimer's disease’). Direct approaches were used more often with people with lower cognitive test scores. Doctors emphasised that the dementia was mild and tended to downplay its progression, with some avoiding discussing prognosis altogether.

Conclusions
Doctors are naming dementia to patients. Direct approaches reflect attempts to ensure clear diagnosis. Downplaying and avoiding prognosis demonstrates concerns about preserving hope but may compromise understanding about and planning for the future.

Publication Type: Article
Additional Information: This article has been published in a revised form in British Journal of Psychiatry https://doi.org/10.1192/bjp.2017.64. This version is free to view and download for private research and study only. Not for re-distribution or re-use. © The Royal College of Psychiatrists 2018.
Subjects: R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health Sciences > Healthcare Services Research & Management
URI: http://openaccess.city.ac.uk/id/eprint/22223
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