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An Australian community jury to consider case-finding for dementia: Differences between informed community preferences and general practice guidelines

Abstract

BACKGROUND: Case-finding for dementia is practised by general practitioners (GPs) in Australia but without an awareness of community preferences. We explored the values and preferences of informed community members around case-finding for dementia in Australian general practice. DESIGN, SETTING AND PARTICIPANTS: A before and after, mixed-methods study in Gold Coast, Australia, with ten community members aged 50-70. INTERVENTION: A 2-day citizen/community jury. Participants were informed by experts about dementia, the potential harms and benefits of case-finding, and ethical considerations. PRIMARY AND SECONDARY OUTCOMES: We asked participants, "Should the health system encourage GPs to practice 'case-finding' of dementia in people older than 50?" Case-finding was defined as a GP initiating testing for dementia when the patient is unaware of symptoms. We also assessed changes in participant comprehension/knowledge, attitudes towards dementia and participants' own intentions to undergo case-finding for dementia if it were suggested. RESULTS: Participants voted unanimously against case-finding for dementia, citing a lack of effective treatments, potential for harm to patients and potential financial incentives. However, they recognized that case-finding was currently practised by Australian GPs and recommended specific changes to the guidelines. Participants increased their comprehension/knowledge of dementia, their attitude towards case-finding became less positive, and their intentions to be tested themselves decreased. CONCLUSION: Once informed, community jury participants did not agree case-finding for dementia should be conducted by GPs. Yet their personal intentions to accept case-finding varied. If case-finding for dementia is recommended in the guidelines, then shared decision making is essential.

Type Journal
ISBN 1369-7625 (Electronic) 1369-6513 (Linking)
Authors Thomas, R.; Sims, R.; Beller, E.; Scott, A. M.; Doust, J.; Le Couteur, D.; Pond, D.; Loy, C.; Forlini, C.; Glasziou, P.
Responsible Garvan Author A/Prof Clement Loy
Publisher Name HEALTH EXPECTATIONS
Published Date 2019-06-01
Published Volume 22
Published Issue 3
Published Pages 475-484
Status Always Electronic
DOI 10.1111/hex.12871
URL link to publisher's version https://www.ncbi.nlm.nih.gov/pubmed/30714290