Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice

BACKGROUND: Dementia is an insidious and stigmatised condition, and research indicates that GPs find communicating this diagnosis particularly problematic. Delays in diagnosis may impede optimal patient care. Little research has been published on Australian GPs' perceptions of barriers to disclosing the diagnosis of dementia. AIM: To explore GPs' perceptions of barriers to disclosing the diagnosis of dementia. DESIGN AND SETTING: Qualitative study in the general practice consultation context. METHOD: Semi-structured, audiorecorded interviews were conducted with GPs from three capital cities and one regional centre in Australia. Interviews were transcribed verbatim and thematic analysis was conducted. RESULTS: GPs' lack of confidence in having a correct diagnosis, concern to act in patients' best interests, and the stigma associated with the `dementia' label influenced the disclosure process. GPs found it challenging to identify dementia in the consultation context. It was difficult to raise the issue when both the patient and their family/carer(s) ignore/are unaware of symptoms of cognitive decline. Referral to a specialist was favoured to confirm suspicions, although this did not always result in a definitive diagnosis. Opinions differed as to whether the GP or the specialist was better placed to deliver the diagnosis. GPs preferred disclosure to the patient with his/her family/carer(s) present; associated issues of confidentiality and the importance of offering hope emerged. The severity of the patient's dementia also guided the diagnostic disclosure process. GPs often used euphemisms for dementia when disclosing the diagnosis, to soften the message. CONCLUSION: Complex issues surround the disclosure of dementia. Communicating this diagnosis remains particularly challenging for many GPs.Jill Phillips, Constance Dimity Pond, Nerida Elizabeth Paterson, Cate Howell, Allan Shell, Nigel P. Stocks, Susan M. Goode and John E. Marle