Doing the Right Thing? General Practitioners' Considerations in Achieving a Timely Dementia Diagnosis

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2024-09-04 DOI:10.1002/gps.6142

Fleur C. W. Visser, Marlise E. A. van Eersel, Hester J. van der Zaag-Loonen, Liesbeth Hempenius, Marieke Perry, Barbara C. van Munster

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引用次数: 0

Abstract

Objectives

Timely detection and diagnosis of dementia are beneficial for providing appropriate, anticipatory care and preventing acute situations. However, initiating diagnostic testing is a complex and dynamic process that requires general practitioners (GPs) to balance competing priorities. Previously identified barriers, such as a lack of time, knowledge, and resources, may not fully represent the challenges involved in this process. Therefore, this study aimed to examine GPs' more implicit considerations on starting the diagnostic trajectory for dementia.

Methods

A qualitative study was conducted using semi-structured interviews with 14 Dutch GPs who were purposively selected through maximum variation sampling. The interview transcripts were inductively analyzed in multiple rounds by a multidisciplinary research team using thematic analysis.

Results

GPs' considerations on starting the diagnostic trajectory for dementia can be summarized in three main themes that are interconnected: (1) ‘the presumed patient's willingness’, that is, facing a dilemma of wanting to respect patient autonomy in cases of denial or an absence of a diagnostic request, while at the same time identifying a problem and feeling the urgency to act; (2) ‘the GP's attempt not to harm’, that is, balancing between not wanting to harm the patient and/or relatives with the burdensome label of dementia and with the possible negative consequences of a late diagnosis; and (3) ‘time, trust, and interprofessional collaboration influence timeliness of diagnostic work-up’, that is, time available for consultations, time as a diagnostic factor, GP's diagnostic confidence, and trustful physician–patient relationship.

Conclusions

This study revealed that important ethical dilemmas regarding patient autonomy and the principle of doing no harm lie behind practical GP barriers to initiating diagnostic testing for dementia. Time, trust, and interprofessional collaboration were found to facilitate GPs in determining the right decision and timing with each individual patient and their relatives. Future research could explore the value of diagnostic decision aids that explicitly involve patients and their relatives in this balancing act.

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做正确的事？全科医生在及时诊断痴呆症时的考虑因素》（General Practitioners' Considerations in Achieving a Timely Dementia Diagnosis）。

目的：及时发现和诊断痴呆症有利于提供适当的预见性护理和预防急性病症。然而，启动诊断检测是一个复杂而动态的过程，需要全科医生（GPs）平衡相互竞争的优先事项。以前发现的障碍，如缺乏时间、知识和资源，可能并不能完全代表这一过程中所涉及的挑战。因此，本研究旨在探讨全科医生在开始痴呆诊断过程中更多的隐性考虑因素：本研究采用半结构式访谈法对 14 名荷兰全科医生进行了定性研究。多学科研究小组采用主题分析法对访谈记录进行了多轮归纳分析：结果：全科医生在开始诊断痴呆症时的考虑可归纳为三个相互关联的主题：(1) "推测患者的意愿"，即在患者拒绝或没有提出诊断要求的情况下，面临既要尊重患者自主权，又要发现问题并感到迫切需要采取行动的两难境地；(2) "全科医生避免伤害的尝试"，即在不希望给患者和/或亲属贴上沉重的痴呆症标签，以及不希望因诊断过晚而可能带来的负面影响之间取得平衡；以及 (3) "时间、信任和跨专业合作影响诊断工作的及时性"，即可用于会诊的时间、作为诊断因素的时间、全科医生的诊断信心以及信任的医患关系。结论本研究揭示了全科医生在启动痴呆症诊断检测时面临的重要伦理困境，这些困境涉及患者自主权和 "不伤害 "原则。研究发现，时间、信任和跨专业合作有助于全科医生与每位患者及其亲属共同决定正确的决策和时机。未来的研究可以探索诊断决策辅助工具的价值，让患者及其亲属明确参与到这一平衡行动中来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.