Educating General Practitioners about Dementia

It is widely acknowledged that facilitating the timely diagnosis of dementia offers the opportunity for patients and their families to plan for the future, access to treatments and support services, reduce family member stress, enable caregivers to adapt to the caregiver role,), provide effective support and delay admission to residential aged care. Importantly, timely diagnosis enables the person with dementia to actively participate in decision making about the future whilst they are able.

General practitioners (GPs) play a key role in supporting people with dementia and their families across the dementia trajectory. Importantly they have a primary role in facilitating a dementia diagnosis, a point which many GPs acknowledge. Indeed, in the majority cases involving dementia the GP is the first health professional to be consulted. Yet while the literature suggests GPs have positive attitudes toward caring for people with dementia, many people with dementia symptoms remain undiagnosed. Of concern, evidence suggests that a third of GPs never disclose a dementia diagnosis or do not routinely disclose a diagnosis to a patient. Moreover, recent research highlights that just over half of adults with probable dementia have either not been diagnosed or were unaware of their diagnosis.

There are several potential reasons why dementia diagnosis rates remain low, or why a diagnosis might be delayed. Patient barriers include stigma, reluctance to know a diagnosis of dementia, refusal to be tested or treated, concealment of symptoms, together with minimisation of, or ignoring early signs and symptoms.

From a GP perspective, barriers to diagnosis often revolve around the difficulties associated with diagnosing dementia given the often-complex presentations, especially in its early stages. Evidence also highlights problems with GPs’ knowledge and skill deficits, while low rates of diagnosis or delayed diagnosis have also been associated with a GP’s attitudes surrounding the benefits of making a diagnosis, the efficacy of medical treatments and or confidence in their clinical abilities to not only diagnose and communicate a diagnosis, but also treat and or manage dementia related symptoms.

While training has been shown to increase the knowledge of participants, research has also indicated that knowledge is only one part of the equation in the translation of knowledge into clinical practice, and that attitudes and perceptions of self-efficacy play a key role in relation to how a GP might approach management of dementia. A survey that is both valid and can reliably measure these constructs provides insights into how educational interventions impact on attitudes and confidence, as well as providing a basis from which to develop future interventions that specifically target any deficiencies in either.

Objectives:

Develop and test a tool to measure the attitudes and confidence of GPs towards the diagnosis, treatment and management of dementia
Determine whether educational interventions improve attitudes, knowledge and confidence.

Research Team:

Funding:

The JO and JR Wicking Trust

Outputs:

Mason, R., Doherty, K., Eccleston, C., Winbolt, M., Long, M. and Robinson, A., 2020. Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pre-test post-test study. BMJ open, 10(1).

Tierney, L., Mason, R., Doherty, K., Winbolt, M., Long, M. and Robinson, A., 2019. Workshops on diagnosis and management of dementia for general practitioners: a pre–post intervention study of dementia knowledge. BMJ open, 9(4), p.e027804.

Mason, R., Doherty, K., Eccleston, C., Annear, M., Lo, A., Tierney, L., McInerney, F. and Robinson, A., 2019. General practitioners’ attitude and confidence scale for dementia (GPACS-D): confirmatory factor analysis and comparative subscale scores among GPs and supervisors. BMC family practice, 20(1), pp.1-8.

Mason, R.L., Annear, M.J., Lo, A., McInerney, F., Tierney, L.T. and Robinson, A.L., 2016. Development and preliminary psychometric properties of the General Practitioner Attitudes and Confidence Scale (GPACS–D) for dementia. BMC family practice, 17(1), p.105.