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

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Abstract

Background

Among health professionals, there is wide variation in the practice of disclosing a diagnosis of dementia to patients.

Purpose

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.

Method

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.

Results

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.”

Conclusions

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.

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Acknowledgments

We are grateful to all members of mental health teams who participated in the study. This project was funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is 50% funded by the Chief Scientist Office of the Scottish Government Health Directorate.

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Authors and Affiliations

  1. Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK

    Martin P. Eccles, Robbie Foy, Claire Bamford, Jan Lecouturier, Nick Steen & Paula M. Whitty

  2. Health Services Research Unit, University of Aberdeen, Health Services Building, Foresterhill, Aberdeen, AB25 2ZD, UK

    Jill Francis

  3. School of Psychology, University of Aberdeen, Aberdeen, AB24 2UB, UK

    Marie Johnston

  4. Clinical Epidemiology Programme, Ottawa Health Research Institute and Department of Medicine, University of Ottawa, 1053 Carling Avenue, Room 2-018, Administrative Services Building, Ottawa, Ontario, K1Y 4E9, Canada

    Jeremy M. Grimshaw

  5. Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK

    Julian Hughes

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  1. Martin P. Eccles
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  2. Jill Francis
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Correspondence to Martin P. Eccles.

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Eccles, M.P., Francis, J., Foy, R. et al. Improving Professional Practice in the Disclosure of a Diagnosis of Dementia: A Modeling Experiment to Evaluate a Theory-Based Intervention. Int.J. Behav. Med. 16, 377–387 (2009). https://doi.org/10.1007/s12529-008-9023-3

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  • DOI: https://doi.org/10.1007/s12529-008-9023-3

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