Would you like to know what is wrong with you? On telling the truth to patients with dementia

Marzanski, Marek

doi:10.1136/jme.26.2.108

Cited by 105 publications

(71 citation statements)

References 28 publications

(16 reference statements)

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Section: Gppmentioning

confidence: 99%

“…Health care professionals should therefore seek to understand their patients' preferences with respect to the diagnosis of dementia and act appropriately according to their choice. 58 Studies have shown that the vast majority of patients with mild dementia wish to be fully informed. [59][60] Therefore, unless a patient suffering from dementia explicitly declines to be informed of the diagnosis, the default mode should be to inform truthfully as it will enable the patient to:…”

Section: Grade D Levelmentioning

confidence: 99%

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Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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Section: Gppmentioning

confidence: 99%

Section: Grade D Levelmentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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“…Evidence exists that most individuals with dementia would like to receive information concerning their diagnosis (Karlawish et al 2005, Marzanski, 2000. On the other hand, the question of when, to whom, and how to communicate information regarding a suspected diagnosis, with all its implications, including loss of the patient's memory of experiences, must take to account several aspects.…”

Section: Legal Implications Of Incapacitymentioning

confidence: 99%

End of Life Care: Attitudes Toward Autonomy and Legal Instruments

Schelp¹

2012

Geriatrics

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“…16,17 The effects on the needs for early diagnosis, financial and legal aspects of the disease, and meaningful activities were not studied. CM was not found to have any effect on patients' daily activities, cognition and depression.A meta-analysis of the effects of CM (Figure 1 and Supplemental Appendix 4, available at http:// 61,62,66,73,74,76,81,85,91,93,95,97 Canada 84 USA [14][15][16] Europe (21 studies) UK 20,52,53,64,69,72,77,78,83,84,99 The Netherlands The effect on depression of caregivers was uncertain (SMD -0.23, 95% CI, -0.46 to 0.01, P = .06), 14,17,18 and there was no effect on caregivers' burden (SMD 0.17, 95% CI, -0.18 to 0.52, P = .34). …”

mentioning

confidence: 99%

“…Education/ counseling [59][60][61][62][63][64][65][66][67][68][72][73][74][75]79,80,82,[85][86][87][88][89][92][93][94][95][96][97] Need for specific information on medical and interpersonal aspects of the disease, meaningful counseling on dealing with behavioral problems, guidelines on dementia before and after diagnosis.…”

mentioning

confidence: 99%

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

Khanassov

Vedel

2016

Ann Fam Med

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PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patientcaregiver dyad and the effects of CM. METHODSWe searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified.RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care.CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patientcaregiver dyad. 2016;14:166-177. doi: 10.1370/afm.1898. Ann Fam Med INTRODUCTIONT he proportion of people with dementia is growing dramatically. According to the US Alzheimer's Association, by 2030, 50% of Americans aged 65 years and older will be diagnosed with dementia. 1 In Canada in 2011, 747,000 Canadians lived with cognitive impairment.2 Today, the combined costs are $33 billion per year, 1 and they are projected to increase to $872 billion by 2038. 3,4 Worldwide, dementia is the main contributor to disability-adjusted life years (11.2%), representing a greater burden than cerebral vascular accident (9.5%), heart disease (5.0%), or cancer (2.4%). 5People with dementia need help with challenging changes in behavior, memory, physical disability, and mood. 6 The main source of help is family caregivers, who often suffer from the burdens of caregiving and from depression and health problems. 7 It has been shown that early intervention makes the greatest difference in management of symptoms. 1 The World Health Organization states that it would be challenging to intervene without effective involvement of primary care. 8 Dementia case management (CM) interventions are becoming a central component of primary health care organizations in North America and Europe. [9][10][11][12] According to the 167Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communi...

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Would you like to know what is wrong with you? On telling the truth to patients with dementia

Cited by 105 publications

References 28 publications

Systematic review of recent dementia practice guidelines

Systematic review of recent dementia practice guidelines

End of Life Care: Attitudes Toward Autonomy and Legal Instruments

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

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