Communication Between Family Physicians and Individuals with Dementia at the Time of Diagnosis

Abstract

Physicians are usually the first contact in the health care system for persons with dementia and their family caregivers. Although specialists typically make the diagnosis, it is the family physician who is key to confirming the diagnosis for dementia, explaining what it means physically, emotionally, and describing what to expect as the disease progresses. Our knowledge about interaction between persons with dementia and their physicians is based largely on the caregiver's view while few studies have investigated the physician's perspective. Persons with dementia have been underrepresented in research pertaining to the issue of diagnosis disclosure. The aim of this exploratory study was to examine the attitudes of family physicians and individuals with early stage dementia about the diagnostic process. The effects of a companion on a medical encounter were also investigated. Data were compiled from responses of 14 family physicians to a structured questionnaire containing highly selective questions, as well as in-depth interviews with 9 individuals with dementia. Using a conflict theoretical framework, the results show that family physicians do inform patients of a diagnosis for dementia. Although the majority of individuals with dementia are satisfied with their family physicians' communication, they were dissatisfied in terms of referral to community resources. Persons with dementia also felt that they received less than ideal care, particularly from specialists, in terms of how the diagnosis was disclosed. Overall, physicians and persons with dementia rated the influence of a third person in the medical encounter as positive. Physicians in this study continued to use an illness-centered approach rather than a patient-centered approach that acknowledges the patient as a person with unique needs and a life-story. Future research thus needs to address the development of a patient-centered model in which the understanding of the subjective experience of the person with dementia is essential.