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Improving Professional Practice in the Disclosure of a Diagnosis of Dementia: A Modeling Experiment to Evaluate a Theory-Based Intervention

Lookup NU author(s): Professor Martin Eccles, Dr Jill Francis, Dr Robbie Foy, Professor Marie Johnston, Claire Bamford, Professor Jeremy Grimshaw, Joan Hughes, Jan Lecouturier, Dr Nick Steen, Dr Paula Whitty

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Abstract

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.


Publication metadata

Author(s): Eccles MP, Francis J, Foy R, Johnston M, Bamford C, Grimshaw JM, Hughes J, Lecouturier J, Steen N, Whitty PM

Publication type: Article

Publication status: Published

Journal: International Journal of Behavioral Medicine

Year: 2009

Volume: 16

Issue: 4

Pages: 377-387

ISSN (print): 1070-5503

ISSN (electronic): 1532-7558

Publisher: Springer New York LLC

URL: http://dx.doi.org/10.1007/s12529-008-9023-3

DOI: 10.1007/s12529-008-9023-3


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