title: Psychosocial factors that shape patient and carer experiences of dementia diagnosis and treatment: a systematic review of qualitative studies.
abstract: BACKGROUND
  Early diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice.
  
  
  RESULTS
  We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis.
  
  
  CONCLUSIONS
  There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom. f.bunn@herts.ac.uk
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
authors.forename: Katie
authors.initials: K
authors.lastname: Sworn
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.forename: Elaine
authors.initials: E
authors.lastname: McNeilly
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research