Read the summary and the most important questions on Advanced CN research designs week 8

• 1 Issues in disclosing a diagnosis of dementia

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• Name 5 factors that should be considered in the choice of disclosing a diagnosis of dementia yes or no

  1. Capacity
  
  2. Awareness/insight
  
  3. Autonomy
  
  4. Harm
  
  5. Truth telling

• A factor to consider whether or not to disclose a diagnosis of dementia is capacity. What is ment by this?

  Mental capacity is a persons ability to comprehend, process, informed decision-making. The last factor is influenced by cognitive decline associated with dementia. Brings up the issue with informed consent. NP decides whether pt. benefit from knowledge of receiving diagnosis dementia. Pt. capacity is determined according to setting, situation and specific skills. This must be assessed frequently due to dynamic nature of dementing process.

• A factor to consider whether or not to disclose a diagnosis of dementia is Awareness or insight. What is ment by this?

  Ability of patient to possess good insight in deficits (knows severity, nature, consequences) is associated with patients response to receiving diagnosis dementia. The more aware of deficits the more likely experiencing psychological outcomes.  Impair insight not always due to dementia: may be linked to denial and patients inability to cope with bad news.  Presence denial adds other dimension to decision of disclosure: consider nature of etiology of lack of insight and effect of disclosure on patient

• A factor to consider whether or not to disclose a diagnosis of dementia is harm. What is ment by this?

  Consideration of psychological impact diagnosis may have on patient (psychological harm). Although there seems to be no evidence of depression after disclosure but more short-term negative effect. But NP should take into account pt. history of depression and coping skills

• A factor to consider whether or not to disclose a diagnosis of dementia is truth telling. What is ment by this?

  Helping patient and giving best treatment means giving patients best information available. Patients often wish just to be told the truth (not ‘memory problems’ but diagnosis dementia). Not being truthful can compromise professional relationship. Loss of trust increases likelihood patient having negative emotional response

• What can be concluded from the paper by Cornett & Hall (2008)?

  Disclosure outweighs the disadvantages of not telling 
  
  Timely knowledge of diagnosis may help patient to make lifestyle changes and put personal affairs in order prior to becoming incapable to do so on their own    

• 2 Informed consent in clinical neuropsychology practice: Official statement of the National Academy of Neuropsychology

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• What are the options pt. are allowed to explore with informed consent?

  1. responsibility own welfare
  
  2. consideration cost and benefits
  
  3. alternative offers for services and procedures

• What are the key elements of informed consent?

  1. Autonomy
  
  2. nonmaleficence 
  
  3. beneficence

• What 5 aspects should an informed consent include?

  (1) nature and purpose of assessment (2) fees (3) involvement third parties (4) limits of confidentiality (5) patient should be given opportunity to ask questions

• What are additional consideration regarding informed consent?

  1. Children and forensic cases assumed to be incapable of giving informed consent but: should be provided basic information about procedures, preferences and assent should be documented 
  
  2. Consent in patients primary language is essential proper communication and comprehension of information + consideration cultural factors