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The meaning and experience of well-being in dementia for psychiatrists involved in diagnostic disclosure: a qualitative study

Published online by Cambridge University Press:  17 October 2016

A. Vince
Affiliation:
Department of Psychological Health and Well-being, University of Hull, Cottingham Road, Kingston-Upon-Hull, HU6 7RX, UK
C. Clarke
Affiliation:
Department of Psychological Health and Well-being, University of Hull, Cottingham Road, Kingston-Upon-Hull, HU6 7RX, UK
E. L. Wolverson
Affiliation:
Department of Psychological Health and Well-being, University of Hull, Cottingham Road, Kingston-Upon-Hull, HU6 7RX, UK
Corresponding
E-mail address:

Abstract

Background:

Literature indicates that people's experiences of receiving a diagnosis of dementia can have a lasting impact on well-being. Psychiatrists frequently lead in communicating a diagnosis but little is known about the factors that could contribute to potential disparities between actual and best practice with regard to diagnostic disclosure. A clearer understanding of psychiatrists’ subjective experiences of disclosure is therefore needed to improve adherence to best practice guidelines and ensure that diagnostic disclosure facilitates living well with dementia.

Methods:

This study utilized qualitative methodology. Semi-structured interviews conducted with 11 psychiatrists were analyzed using Interpretive Phenomenological Analysis (IPA).

Results:

Three superordinate and nine subordinate themes emerged from the data analysis. These included the following: (i) “The levels of well-being” (Continuing with life, Keeping a sense of who they are, Acceptance of the self), (ii) “Living well is a process” (Disclosure can set the scene for well-being, Positive but realistic messages, Whose role it is to support well-being?), and (iii) Ideal care versus real care (Supporting well-being is not prioritized, There isn't time, The fragmentation of care).

Conclusions:

Findings indicate that psychiatrists frame well-being in dementia as a multi-faceted biopsychosocial construct but that certain nihilistic attitudes may affect how well-being is integrated into diagnostic communication. Such attitudes were linked with the perceived threat of dementia and limitations of post-diagnostic care. Behaviors used to manage the negative affect associated with ethical and clinical tensions triggered by attempts to facilitate well-being at the point of diagnosis, and their impact on adherence to best practice disclosure, are discussed.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2016 

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