8 research outputs found

    The meaning and experience of well-being in dementia for psychiatrists involved in diagnostic disclosure: a qualitative study

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    Literature indicates that people's experiences of receiving a diagnosis of dementia can have a lasting impact on well-being. Psychiatrists frequently lead in communicating a diagnosis but little is known about the factors that could contribute to potential disparities between actual and best practice with regard to diagnostic disclosure. A clearer understanding of psychiatrists’ subjective experiences of disclosure is therefore needed to improve adherence to best practice guidelines and ensure that diagnostic disclosure facilitates living well with dementia. This study utilized qualitative methodology. Semi-structured interviews conducted with 11 psychiatrists were analyzed using Interpretive Phenomenological Analysis (IPA). Three superordinate and nine subordinate themes emerged from the data analysis. These included the following: (i) “The levels of well-being” (Continuing with life, Keeping a sense of who they are, Acceptance of the self), (ii) “Living well is a process” (Disclosure can set the scene for well-being, Positive but realistic messages, Whose role it is to support well-being?), and (iii) Ideal care versus real care (Supporting well-being is not prioritized, There isn't time, The fragmentation of care). Findings indicate that psychiatrists frame well-being in dementia as a multi-faceted biopsychosocial construct but that certain nihilistic attitudes may affect how well-being is integrated into diagnostic communication. Such attitudes were linked with the perceived threat of dementia and limitations of post-diagnostic care. Behaviors used to manage the negative affect associated with ethical and clinical tensions triggered by attempts to facilitate well-being at the point of diagnosis, and their impact on adherence to best practice disclosure, are discussed

    Wellbeing in dementia

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    The portfolio thesis is divided into three parts:Part one is a systematic literature review exploring the relationship between self and staff-proxy assessments of quality of life in dementia. The review aimed to provide an exploration into the relationship between ratings made between self and staff-proxy rating as well as the factors that may explain or predict any differences between ratings. A systematic search of four databases identified 12 relevant studies. The findings of the studies are analysed using narrative synthesis and forest plots. Results are discussed in relation to clinical practices and research.Part two is an empirical paper that explores the subjective understandings and lived experiences of Old Age Psychiatrists in relation to positive wellbeing in dementia. Qualitative data was collected using semi-structured interviews and analysed using Interpretive Phenomenological Analysis (IPA). Eleven psychiatrists from three NHS Trusts participated in the research. Three super-ordinate themes and nine sub-ordinate themes emerged from the data. These themes are discussed in relation to the wider literature base.Part three comprises the appendices supporting the systematic literature review and empirical paper. It also includes a reflective statement of the primary researcher’s experiences of the research process

    Increasing uptake of ecosystem service assessments: best practice check-lists for practitioners in Europe

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    Aiming at understanding the role of plural values in decision-making, the IPBES Values Assessment defined nature valuation broadly as including biophysical, economic and socio-cultural assessments, including ecosystem service assessment. IPBES reviews of scientific literature revealed a lack of documentation of uptake by stakeholders across method types. The EU project SELINA aims to contribute to increasing uptake of ES assessments at different governance levels. This paper reviews guidance in national and local applications by compiling study design recommendations for ES assessments from 111 guidance documents on ES assessments covering 12 European languages. Guidance documents are evaluated for seven diagnostic topics suggested to increase relevance and robustness of ES assessments: ecosystem condition variables; capacity-potential; supply-demand; spatial scaling and resolution capability; social and health benefit compatibility; economic valuation compatibility; and uncertainty assessment. The paper develops the guidance recommendations across these topics into a set of checklists for practitioners and contractors of ES assessments. We find synergies between these study design features and gaps in guidance in relation to the policy cycle. Checklists are aimed at projects self-assessing and improving their design and implementation to increase robustness of their ES assessment. From a knowledge supply perspective, this is expected to increase the likelihood of uptake of results by stakeholders. We end the paper with some cautions on limitations to uptake from different perspectives and the demand for and political uses of ES assessment knowledge