Background
Methods
Search strategy
Inclusion and exclusion criteria
Outcomes
Identification of studies
Quality assessment
Data extraction
First Author | Country | N. | Population | Study type | Quality rating |
---|---|---|---|---|---|
Boise L (2010) | USA | 199 | Clinicians and medical assistants | Intervention | Medium |
Boise L (1999) | USA | 78 | Primary care physicians | Focus groups | High |
Bond J (2010) | EU | Not reported | Clinicians, payers and general public | Survey | High |
Borson SJ (2007) | USA | 26 | Medical assistants | Intervention | High |
Boustani M (2011) | USA | 206 | Caregivers and non-caregivers | Survey | High |
Boustani M (2008) | USA | 315 | Primary care patients’ | Survey | High |
Boustani M (2003) | USA | 318 | Older adults | Survey | High |
Brodaty H (1994) | Australia | 1473 | General practitioners | Survey | Medium |
Bush C (1997) | USA | 360 | Primary care physicians | Survey | Medium |
Cahill S (2008) | Ireland | 307 | General practitioners | Survey | Medium |
Carpenter CR (2011) | USA | 55 | Physicians and Nurses | Survey | Medium |
Dale W (2006) | USA | 149 | Adults | Survey | Medium |
Dale W (2008) | USA | 199 | Older adults | Intervention | Medium |
Downs M (2000) | UK | 278 | General practitioners | Survey | High |
Fowler R (2012) | USA | 554 | Primary care patients’ | Survey | High |
Galvin JE (2011) | USA | 1024 | Health care professionals | Pre-post test | High |
Galvin JE (2008) | USA | 1039 | Older adults | Survey | Medium |
Hansen EC (2008) | Australia | 24 | General practitioners | Focus groups | Medium |
Holsinger T (2011) | USA | 345 | Primary care patients’ | Survey | High |
Iliffe S (1994) | UK | 412 | Older adults | Survey | Medium |
Iliffe S (2003) | UK | 247 | Health care professionals | Workshop and survey | Medium |
Iracleous P (2010) | Canada | 249 | Primary care physicians | Survey | Medium |
Justiss MD (2009) | USA and UK | 245 | Older adults | Survey | High |
Krohne K (2011) | Norway | 18 | Older adults | Observational | Medium |
Lawrence JM (2003) | USA | 787 | Clinicians and community-dwelling individuals | Intervention and survey | Medium |
Manthorpe J (2003) | UK | Not reported | Health care professionals | Workshop and survey | Medium |
Martinez-Lage P (2010) | EU | 500 | Physicians | Survey | Medium |
Welkenhuysen M (1997) | Belgium | 167 | Medical students | Survey | Medium |
Williams CL (2010) | USA | 119 | Adults | Interview | Medium |
Theme | Reference |
---|---|
Pre-screen
| |
Stigma and awareness of disease | 22, 24, 27, 29, 30, 31, 33, 34, 35, 36, 38, 39, 43, 43, 47, 50 |
Role of family | 27, 31, 32, 34, 36, 37, 38, 39 |
Existing health | 22, 27, 31, 34, 36, 40 |
Health insurance/financial/Employment/driving | 21, 28, 35, 43 |
Duration of contact | 46 |
Locality | 37, 46 |
Current practice/practicalities | 36, 38, 40, 42, 44, 45, 49, 50 |
Lifestyle and life view | 21, 24, 26, 27, 28, 29, 33, 37, 48, 50 |
Training | 22, 31, 34, 36, 39, 47, 49, 50 |
In-screen
| |
Time constraints | 36, 41, 44, 45, 46 |
Inaccuracy of test | 41, 45 |
Cost | 38, 45 |
Communication | 22 |
Post-screen
| |
Lack of change in prognosis, treatment and patient benefit | 21, 23, 24, 26, 27, 28, 29, 31, 32, 33, 35, 36, 37, 38, 39, 41, 42, 44, 45, 47, 48, 49 |
Role of support | 30, 37 |
Data analysis
Results
Search results
Sample characteristics
Study characteristics
Risk of bias
Attitudes and preferences
Themes in relation to the patient, carer and general population:
“It wasn’t that it couldn’t be done, but at my age… I got tired – this is a weariness I carry with me everywhere (and it kicks in every time) I’m exposed to something complicated.” [22]
“It [the screening test] is probably to do a little bit of research on what we remember, and… if our heads are where they are supposed to be…” [22]“…she tested my head, that’s what she did.” [22]“I got the impression that I passed the test. Yes. Or you could say it was examination questions, right?” [22]
“No, I wasn’t told. I don’t know.” [22]“[I]f I was to guess (…) it has something to do with memory?” [22]
“I’m over 50 with no children. I need to know how to be prepared.” [34]“[they can] catch it before it’s too late.” [34]
“I’d say in 90 % of the cases it’s the family [that brings the dementia to my attention].” [36]
Themes in relation to healthcare professionals:
“When we do see people for dementia, it is common that they have ten other medical problems. There’s usually something else going on - dementia or memory problems is right at the bottom of the list, in terms of things to address.” [34]
“I know I’m guilty of it, and suspect the rest of us are too . . . which is that, with someone who’s been your patient for a while and, you haven’t done a Mini-Mental State Exam on them…” [45]“Very often you know these patients very, very well and have seen them over many years … and maybe you don’t notice, because of your lack of memory … their lack of memory and then it’s really only when a crisis occurs… something happens that sort of makes everybody stand back and say ‘Oh my God, it’s really obvious’ and made it difficult for most to administer the MMSE (Mini Mental State Examination).” [45]
“The MMSE is quite distressing… to do with a patient you know, I think it’s quite an invasive test… I think part of the problem is that the minute you start doing it, it’s…very direct.” [45]
“I’ve walked out of the room lots of times going ‘I think something’s going on here but not pushed it, because what am I going to do? What am I going to tell the family?’ Well, they’re functioning okay in the home, I think they’ve probably got early dementia, but is it going to change anything? No. Can I do anything about it? No. So, why get everybody all excited when we’ll just keep a close eye on it.” [36]“The family doesn’t want to hear, the patient doesn't want to hear. The ‘gradual decline of forgetfulness’ is a much better description to the patient and the family.” [36]
“Sounds like there’s some message coming from somewhere [that doctors should be more] aggressive with early diagnosis… If that’s the case that needs to be communicated with some really good reasons. To offset the ‘I don’t want to know, the family doesn’t want to know…’ There [needs to be] something that changes the prognosis.” [36]
“I have the most trouble discussing with the patients and families. I have no problem about cancer or other fatal diseases, but Alzheimer’s disease has a huge stigma associated with it.” [36]