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Disclosure of Alzheimer’s Disease and Dementia: Patient- and Care Partner-Centric Decision-Making and Communication
Disclosing a diagnosis of dementia can be one of the most challenging aspects of care for clinicians. Here, learn strategies for disclosing the diagnosis.
Abstract
Disclosing the diagnosis of cognitive impairment or dementia due to Alzheimer’s disease (AD) and Related Dementias (ADRD) can be one of the most challenging aspects of dementia care for clinicians. However difficult the diagnosis is to give or receive, evidence and evidence-based consensus support that disclosing a timely AD/ADRD diagnosis, accompanied by psychoeducation and care planning, is beneficial to patient-care partner dyads. Diagnosis, provided as early as possible, increases the likelihood for patients to be involved in decision-making and planning for their future and allows care options to be implemented sooner to provide greater clinical and quality-of-life benefits, reduce potential for harm, and mitigate symptoms and decline. Using patient-centered communication and following a structured process, clinicians can provide a successful disclosure of diagnosis as a component of the necessary foundation to implement impactful management and care planning for patients and caregivers going through a life-changing process.
From the Series: A Multidisciplinary Approach for Addressing Challenges in Alzheimer’s Disease
To cite: Goldfarb D, Sheard S, Shaughnessy L, et al. Disclosure of Alzheimer’s disease and dementia: patient- and care partner–centric decision-making and communication. J Clin Psychiatry. 2019;80(2):MS18002BR1C.
To share: https://doi.org/10.4088/JCP.MS18002BR1C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
Neurologists, psychiatrists, primary care clinicians, nurse practitioners/physician assistants
Learning Objectives
Knowledgably and compassionately disclose a dementia diagnosis to patients and their caregivers
Support Statement
Supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Knowledgably and compassionately disclose a dementia diagnosis to patients and their caregivers
Release, Review, and Expiration Dates
This brief report activity was published in February 2019 and is eligible for AMA PRA Category 1 Credit™ through February 28, 2022. The latest review of this material was December 2018.
Statement of Need and Purpose
Clinicians are missing the diagnosis of about half of cases of Alzheimer’s disease (AD) and related dementias. When the illness is being recognized, providers often are not effectively communicating with patients and their care partners regarding the diagnosis and next steps. Clinicians also may not individualize treatment options to manage cognitive and behavioral symptoms in patients with AD. Task-sharing and collaboration must occur between specialists and primary care physicians to address the growing number of individuals with AD. Clinicians need education on early recognition of AD using a stepwise process that includes patient observation, informant report, use of assessment tools, and additional testing or referral, when appropriate. Practitioners also need guidance for sharing the diagnosis of AD along with education and next steps to take, including support services. Finally, providers need current information on pharmacologic and nonpharmacologic treatments for patients with AD.
Disclosure of Off-Label Usage
Dr Atri has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this activity.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
Acknowledgment
This activity is derived from the teleconference “Communication About Alzheimer’s Disease Diagnosis and Management,” which was held on October 3, 2018 and supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporters.
Faculty Affiliation
Danielle Goldfarb, MD
Banner Alzheimer’s Institute, Phoenix, Arizona
Simon Sheard, DO
Banner Health Center, Maricopa, Arizona
Lynn Shaughnessy, PsyD
Ray Dolby Brain Health Center, California Pacific Medical Center, Sutter Health, San Francisco
Alireza Atri, MD, PhD
Banner Sun Health Research Institute, Sun City, Arizona
Financial Disclosure
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Drs Goldfarb, Sheard, and Shaughnessy have no personal affiliations or financial relationships with any commercial interest to disclose relative to the activity. Dr Atri has no equity, shares, or salary from any pharmaceutical or biotechnology company and is not a member of any pharmaceutical company’s speakers’ bureau. Dr Atri has received honoraria for consulting, educational lectures/programs/materials, or medical/scientific advisory/data safety monitoring boards from AbbVie, Allergan, Alzheimer’s Association, Eisai, Harvard Medical School Graduate Continuing Education, Lundbeck, Merck, Roche/Genentech, Suven, and Synexus. Dr Atri’s institution (Banner Health) has received investigational observational study/clinical trial-related funding from Novartis. Dr Atri’s previous institution had contracts for or had received investigational clinical trial–related funding from The American College of Radiology, AbbVie, Avid, Biogen, Lilly, Lundbeck, Merck, and vTV. Dr Atri has received book royalties from Oxford University Press.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation