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

Wolverson, Emma; Clarke, Christopher; Vince, Adrienne

Authors

Dr Emma Wolverson E.Wolverson@hull.ac.uk
Clinical Lecturer and Faculty Ethics Committee Member

Christopher Clarke

Adrienne Vince



Abstract

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

Publication Date Jan 1, 2017
Journal International psychogeriatrics
Print ISSN 1041-6102
Electronic ISSN 1741-203x
Publisher Cambridge University Press (CUP)
Peer Reviewed Peer Reviewed
Volume 29
Issue 1
Pages 93-104
Institution Citation Wolverson, E., Clarke, C., & Vince, A. (2017). The meaning and experience of well-being in dementia for psychiatrists involved in diagnostic disclosure: a qualitative study. International Psychogeriatrics, 29(1), 93-104. https://doi.org/10.1017/S1041610216001484
DOI https://doi.org/10.1017/S1041610216001484
Keywords Dementia, Quality of life, Qualitative research, Alzheimer's disease, Clinical assessment, Wellbeing, Psychiatry
Publisher URL https://www.cambridge.org/core/journals/international-psychogeriatrics/article/div-classtitlethe-meaning-and-experience-of-well-being-in-dementia-for-psychiatrists-involved-in-diagnostic-disclosure-a-qualitative-studydiv/BA74B968528E90E2FD9640DB9490C63E
Copyright Statement ©2017 University of Hull
Additional Information This article has been published in a revised form in International psychogeriatrics http://dx.doi.org/10.1017/S1041610216001484. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © copyright holder.

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