Improving professional practice in the disclosure of a diagnosis of dementia: a modeling experiment to evaluate a theory-based intervention.
BACKGROUND
Among health professionals, there is wide variation in the practice of disclosing a diagnosis of dementia to patients.


OBJECTIVE
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.


METHODS
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.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. martin.eccles@ncl.ac.uk
Martin P
MP
Eccles
Jill
J
Francis
Robbie
R
Foy
Marie
M
Johnston
Claire
C
Bamford
Jeremy M
JM
Grimshaw
Julian
J
Hughes
Jan
J
Lecouturier
Nick
N
Steen
Paula M
PM
Whitty
D001291:Attitude of Health Personnel; D003704:Dementia / Q000175:diagnosis*; D019538:Health Care Surveys; D006801:Humans; D008962:Models, Theoretical; D016544:Patient Simulation; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D014342:Truth Disclosure