Living with Dementia Care Pathways - Coursework Example

Living With Dementia Care Pathways Table of Contents Introduction 3 Critical Assessment of the Research Literature that Explores the Disclosure of a Diagnosis of Dementia to the Person with Dementia and their Carers 4 Explaining Argument Position in Relation to Benefits and Risks of Disclosure 7 Discussion and Evaluation of Conflicting Literature/Findings 7 Linkage between the Literature and Practice Experience 9 Identifying Limitations or Weaknesses of the Evidence 10 Conclusion 11 References 12 Bibliography 16 Introduction In the recent times, many epidemics have spurred, which have negatively influenced the lives of numerous people within a society. In this regard, one of the major health related issues that have lately been emerged as influential human lives is dementia. It is identified that more than 700,000 people are living with dementia in United Kingdom (UK). The disease has been ascertained to be among the major cause of disability, particularly amidst older people, which has imposed radical challenges for families dealing with dementia and health care service providers engaged in diagnosis and treatment of the disease. Due to the growing concerns of increasing number of patients with dementia, considerable importance is laid on early screening and diagnosis of patients having the symptom of dementia (Lee & et. al., 2014; Milne, 2010). Notwithstanding, lately the issue pertaining to the disclosure of a diagnosis of dementia for people with dementia and their carers have emerged as a subject matter of arguments within the medical community. Controversies tend to exist with respect to whether or not to disclose dementia patients and their family members regarding the dementia diagnosis. Notably, this argument is based on the ground that many dementia patients when communicated that their diagnosis tends to develop worries, which have significantly affected their behaviour. While on the other hand, family members or the carers were ascertained to respond poorly when informed about the dementia diagnosis (Prorok & et. al., 2013; Campbell, 2011). Against this backdrop, the essay intends to critically assess the research literature that explores the disclosure of a diagnosis of dementia to the person with dementia and their carers. In addition, the essay further determines the benefits and risks of disclosure for the person with dementia and their carers. Critical Assessment of the Research Literature that Explores the Disclosure of a Diagnosis of Dementia to the Person with Dementia and their Carers The risk of dementia is identified to increase with the growing aging demographic. Almost 35 million people across the world are ascertained to be suffering from dementia. In order to deal with the growing number of patients with dementia, many countries in Europe have been firmly involved in framing appropriate strategies related to healthcare services provided to patients with dementia (Pesonen & et. al., 2013). Despite these efforts of the government, the radical diagnosis gap is ascertained to exist in the UK. Notably, a small number that consists of a third to a half of victim are recognised to receive proper diagnosis. The various factors are determined, which make the diagnosis of dementia difficult. Correspondingly, it has been identified that people are suffering with several non-dementia psychiatric illnesses and psychiatric treatments, which often create difficulties for the diagnosis of dementia (Chrisp & et. al., 2011). Patients suffering from dementia is considered as, ‘an individualized transitional process’, where series of stages can be determined. The early diagnosis of dementia is considered an important aspect for enhancing the well-being of patients with dementia and their carers. At the same time, proper diagnostic information is recognised as one of the basic interventions in the dementia care. Nevertheless, it has been determined that the diagnosis of dementia tends to influence not only the patients diagnosed with dementia but the entire family (Pesonen & et. al., 2013; Belmin & et. al., 2012.). The issue of disclosure with respect to dementia is recognised to be different as compared to other diseases such as cancer. Unlike other illness like cancer, in dementia, patients are identified to suffer from intrinsic alteration of cognition and the ability to make rational judgement thus, affecting the mental wellbeing of the patients to a considerable extent. Correspondingly, this issue further makes the disclosure of diagnosis difficult. Furthermore, it would be vital to consider the moral doctrine pertaining to diagnosis disclosure. Correspondingly, the moral doctrine of diagnosis disclosure forms its basis on the ground of the ‘patients autonomy’ and ‘beneficence’. Reflecting upon the tenet of patients’ autonomy, which provides rights to the patients to acquire any information related to them often, creates moral requirements for the general practitioners to disclose diagnosis to patients. On the other hand, the tenet of non-maleficence, which seek the obligation not to cause harm intentionally often cause differences in the decision making of general practitioners related to informing patients and carers regarding the diagnosis. Accordingly, the truth telling has turned out to be a moral absolute and the patients right to be informed is being paramount, but withholding information regarding diagnosis rests on the principle of preventing harm. In this respect, it has been observed that disclosure of information must complement principle of non-maleficence. Various physicians have reported that disclosure of diagnosis to patients with dementia is associated with development of various types of concerns in patients and their carers. Evidently, the physicians have stated that disclosure made to patients with dementia often result in destroying hope, development of depressive illness, suicide and other catastrophic reaction (Lecouturier & et. al., 2008). In addition, other difficulties are also recognised to demotivate the disclosure of the diagnosis of dementia. In this regard, difficulties associated with accurate diagnosis of dementia impose serious influence on the general practitioners decision to disclose diagnosis to patient with dementia and their carers (Pinner, 2000). It has also been observed that disclosure of diagnosis is also associated with the generation of the feeling of confusions among the patients with dementia. At the same time, both patients and their carers on the disclosure are more likely to express their grief and sadness. Thus, it can be identified that negative consequences associated with the disclosure of a diagnosis of dementia for patients and their carers are often seen to offset the positive consequences of the disclosure (Bunn & et. al., 2012. Robinson & et. al., 2011). Nevertheless, it has also been determined that the carers on the disclosure of the diagnosis are more inclined towards revealing their deep concerns and care for the patient with dementia. The disclosure of diagnosis to patients with dementia and their carers are advocated to provide necessary conditions relevant to making decisions regarding their future. The disclosure is also determined to be crucial for carers, as it provides carers to change their behaviour towards the patient with dementia. Accordingly, the changes in the behaviour that best suited the treatment procedure of a patient with dementia are ascertained to promote positive behaviour amid such a patient with dementia. In other words, the confirmation of the illness, i.e. dementia generates adequate awareness amid the carers, which further facilitates them to appreciate the remaining capacities of patients with dementia. More importantly, the disclosure provides both patients with dementia and their carers with an opportunity to adapt changes according to the need of hour and make planning for future care planning. In addition, the formal disclosure also facilitates in improving the lives of patients and carers as well as it increases the treatment options for patients with dementia (Iliffe & et. al., 2003). Thus, it can be concluded that disclosure of the diagnosis for a person with dementia and their carers is a complex issue. Evidently, the disclosure of diagnosis has both benefits and risks. Thus, based on the potential benefits and risks associated with disclosure of diagnosis, it can be stated that patients with dementia and their carers need to be informed about the diagnosis. However, it is crucial to mention that the general practitioners should disclose diagnosis to a person with dementia and their carers with stress retaining capabilities and strengths (Gridley & et. al., 2014). Explaining Argument Position in Relation to Benefits and Risks of Disclosure It has been argued above that a person with dementia and their carers should be informed about the diagnosis. Correspondingly, in order to justify the argument, various literatures can be identified that would support the argument. In this regard, Holroyd & et. al. (2002) stated that general practitioners should involve informing diagnosis for a person with dementia and their carers. At the same time, it has been stressed that general practitioners should render other supporting information that would reduce any negative feelings that may be experienced by the patient with dementia and their carers (Holroyd & et. al., 2002). Similarly, Mate & et. al. (2012) noted that diagnosis and disclosure of mental health problems are closely related to quality of life in patients with dementia. Accordingly, it has been argued that general practitioners should not evade discussing the diagnosis and related plan with patients (Mate & et. al., 2012). Although, the disclosure of diagnosis for person with dementia and their carers have positive impact, but it has been reported that disclosure is often associated with increasing rate of suicide (Mastwyk & et. al., 2014). Discussion and Evaluation of Conflicting Literature/Findings It has been determined that the published literature pertaining to the disclosure for a person with dementia and their carers is limited. It has been observed from the above assessment that there are various factors that contributes towards the benefits and risks associated with disclosure for a person with dementia and their carers. In this regard, the benefits associated with disclosure are identified to be closely related with the treatment of the patients with dementia. Accordingly, it has been determined that the benefits associated with the disclosure relates to generate adequate awareness amid the patients with dementia and their carers. The disclosure of diagnosis is ascertained to promote care planning for effective treatment of the patients with dementia. The disclosure is also perceived to provide psychological benefits to patients with dementia and their carers. In addition, it is ascertained to maximise the treatment procedures as well as facilitates in making necessary changes essential for providing patients with dementia with confidence to cope up with the illness. The disclosure of diagnosis is also ascertained to raise suspicious feeling among the patients revealing the symptom of dementia and their carers. On the other hand, several factors were also ascertained from the critical assessment of the literature to be negatively related to the disclosure of diagnosis to patients with dementia and their carers. In this regard, risk associated with emotional distress is identified to be a major limiting factor that restricts the general physicians from disclosing the diagnosis. In addition, the inability of the patients with dementia to understand the complexity associated with the illness is also ascertained to be another major determinant of influencing the disclosure of diagnosis. Besides, fear of losing hope and social stigma associated with a diagnosis of dementia is considered as factors that demotivate general practitioners to disclose the diagnosis (Moore & Cahil, 2013.). More importantly, it has been reported that apart from the development of depressive illness and catastrophic reaction, patients on disclosure of diagnosis at times attempts for suicide, which can be regarded as the most severe risk of disclosing the diagnosis. Apart from the above mentioned aspects contributing towards the benefits and risks of disclosure of diagnosis to people with dementia and their carers, certain other influencing factors influence the decision of general practitioners whether or not to disclose. In this regard, it has been determined that severity associated with cognitive impairment, age of the patients along with carers, willingness of patients to be informed and clinician attitude among others plays a crucial part with respect to disclosure or non-disclosure of diagnosis to the patients with dementia and their carers (Bamford & et. al., 2004). It has been ascertained that disclosure of diagnosis, particularly in the case of dementia is not common. It has been observed that only 50% of the geriatricians are openly engaged in discussing the diagnosis with the patients with dementia. It has been reported that only 47% of patient when diagnosed with dementia were formally informed by general practitioners about their diagnosis. A study conducted on the patients with dementia revealed that 66% of the patients suffering from dementia have not been involved in formal discussion regarding their dementia diagnosis with general practitioners, while only 47% reported that they have been informed about their diagnosis and discussed about their illness (Derksen & et. al., 2006). It has been observed that many carers have expressed their views regarding the disclosure of diagnosis to the patients. In this regard, a study conducted to compile the views of carers and family members on information given by health professionals regarding dementia, it has been ascertained that 83% of the carers and family members reported not to disclose the diagnosis to relatives of the patients. While on the other study, it was found that 90% of the respondents, including family members and carers of patients with dementia wished to be informed of the diagnosis. Therefore, the question regarding whether or not to disclose diagnosis has largely been unknown (Maki & Yamaguchi, 2014; Pinner, 2000). Linkage between the Literature and Practice Experience A similar line of belief can be identified with respect to the disclosure of diagnosis for people with dementia and their carers both in literature and practice experience. The analysis of the literature revealed the need for disclosure of diagnosis, but at the same time, it claimed a percentage of disclosure provided by the general practitioner is relatively small, which is evident from the practice experience. Identifying Limitations or Weaknesses of the Evidence It has been advocated in the above argument to inform persons with dementia and their carers regarding the diagnosis. However, the evidences provided above have a certain limitation. Although, many scholars can be seen in favour of disclosing the diagnosis for people with dementia and their carers, but this disclosure is also identified to have serious impact on the person with dementia and their carers. Accordingly, the disclosure is ascertained to deteriorate the mental health of the patients with dementia. At the same time, serious implications are also ascertained to have on the patients and their carer relationships (Peisah & et. al., 2006; Connell & et. al., 2004). Discussion of the Implications of the Position for Practice, Policy and/or Research The argument has been made supporting the disclosure of diagnosis for people with dementia and their carers. The implication of this argument is ascertained to favour the policies framed towards delivering personalised support packages for people living at home. At the same time, the implication of the argument can be clearly identified to support the UK government’s ‘National Dementia Strategy’, which aims at early diagnosis of dementia (Chrisp & et. al., 2012). The implications of the practice that advocates that the disclosure of diagnosis to the patients with dementia and their carers will also support the quality standard for dementia promoted by ‘National Institute for Health and Clinical Excellence’ (NICE) (Manthorpe & et. al., 2013). At the same time, the implication of the practice of the arguments is anticipated to increase the effectiveness of ‘integrated care pathways’ (Rees & et. al., 2004). Conclusion It has been observed from the foregoing discussion that the epidemic of dementia in the recent times has been a major health related issues that has significantly influenced the social lives of the people living with dementia. Another major issue related to decisions regarding the disclosure of diagnosis for people with dementia and their carers. The issue whether or not to disclose the diagnosis for patients with dementia and their caregivers have been subject to major contention. The analysis of the literature revealed both benefits and risks associated with the disclosure. Based on the analysis, it is stressed that general practitioners should disclose the diagnosis to the patient with dementia and their carers. In this regard, it has been observed that disclosure is important for early intervention and promoting quality of lives for both the patients with dementia and their carers. Although, certain risks such as increasing depression, conflicting relationships and development of suicidal tendency have been noted in relation to disclosure, but when dealt tactfully such risks are ascertained to be reduced. Hence, it is firmly advocated to disclose diagnosis for people with dementia and their carers. 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