title: Attitudes and preferences towards screening for dementia: a systematic review of the literature.
abstract: BACKGROUND
  Population screening might provide a mechanism to enable early detection of dementia. Yet the potential benefits, harms or acceptability of such a large-scale intervention are not well understood. This research aims to examine the attitudes and preferences of the general public, health care professionals, people with dementia and their carers towards population screening for dementia.
  
  
  METHODS
  A systematic review of the international literature was undertaken. A search of fifteen bibliographic databases was conducted (up to 12 July 2012; no language restriction) using terms related to dementia, screening, specific screening tools, case finding, and attitudes and preferences; genetic screening and biomarkers were excluded. All study designs were included except opinion-based papers. Included papers were doubly quality assessed and thematically analysed using NVivo.
  
  
  RESULTS
  29,910 papers were identified of which 29 met the inclusion criteria. We identified seventeen themes relating to the 3 phases of the screening process (pre-, in- and post-screen) - none emerged as more of a facilitator than a barrier to the acceptance of dementia screening. Seven themes emerged in relation to the patient, carer and general population: existing health state; lifestyle and life view; awareness of dementia; role of clinician; communication; benefit; and role of the family. Ten themes emerged in relation to the clinician and healthcare professional: patient's existing health and comorbidities; awareness of dementia; confidence; duration of patient contact; suitability of screening tool; cost; disclosure; time; treatment and prognosis; and stigma.
  
  
  CONCLUSIONS
  As for all screening programmes, screening for dementia raises complex issues around preference and choice for clinicians and the public, and it is unclear what specific factors promote or reduce screening acceptance the most. Overall, the level of evidence is low, few large scale studies have been undertaken and none were conducted in representative samples, all affecting the generalizability of identified themes across healthcare contexts. Nevertheless, our findings suggest that population screening for dementia may not be acceptable to either the general public or health care professionals, and highlight where focused efforts are needed to gain insights into dementia specific issues.
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. sm987@medschl.cam.ac.uk.
authors.forename: Steven
authors.initials: S
authors.lastname: Martin
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. sak65@medschl.cam.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kelly
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. ak739@medschl.cam.ac.uk.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khan
authors.affiliation: Academic Unit of Psychiatry, University of Bristol, Bristol, UK. sarah.cullum@nhs.net.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cullum
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK. Tom.Dening@nottingham.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Dening
authors.affiliation: Research Department of Primary Care and Population Health, UCL Medical School, UCL, London, UK. g.rait@ucl.ac.uk.
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.affiliation: Faculty of Medicine and Health Sciences, Norwich, UK Medical School, University of East Anglia, Norwich, UK. Chris.Fox@uea.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: Division of Psychiatry, University College London, London, UK. c.katona@ucl.ac.uk.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. ldc33@medschl.cam.ac.uk.
authors.forename: Theodore
authors.initials: T
authors.lastname: Cosco
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. cb105@medschl.cam.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. ll394@medschl.cam.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Lafortune
mesh_terms: D001291:Attitude of Health Personnel; D003704:Dementia / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening; D057240:Patient Preference