Physicians are usually the first contact in the health care system for persons with dementia and their family caregivers. Although specialists typically make the diagnosis, it is the family physician who is key to confirming the diagnosis for dementia, explaining what it means physically, emotionally, and describing what to expect as the disease progresses. Our knowledge about interaction between persons with dementia and their physicians is based largely on the caregiver's view while few studies have investigated the physician's perspective. Persons with dementia have been underrepresented in research pertaining to the issue of diagnosis disclosure. The aim of this exploratory study was to examine the attitudes of family physicians and individuals with early stage dementia about the diagnostic process. The effects of a companion on a medical encounter were also investigated. Data were compiled from responses of 14 family physicians to a structured questionnaire containing highly selective questions, as well as in-depth interviews with 9 individuals with dementia. Using a conflict theoretical framework, the results show that family physicians do inform patients of a diagnosis for dementia. Although the majority of individuals with dementia are satisfied with their family physicians' communication, they were dissatisfied in terms of referral to community resources. Persons with dementia also felt that they received less than ideal care, particularly from specialists, in terms of how the diagnosis was disclosed. Overall, physicians and persons with dementia rated the influence of a third person in the medical encounter as positive. Physicians in this study continued to use an illness-centered approach rather than a patient-centered approach that acknowledges the patient as a person with unique needs and a life-story. Future research thus needs to address the development of a patient-centered model in which the understanding of the subjective experience of the person with dementia is essential. / Thesis / Master of Arts (MA)

Yes / When face-to-face meetings and events resume, there is likely to be a renewed commitment to involving people with dementia and carers. Clare Mason and colleagues reflect on what they have learnt from their own experience and provide some tips for good practice.

L'étude présentée dans ce mémoire a comparé les effets, à court terme, de l'exposition in vivo jumelée à la physiothérapie usuelle à ceux de la physiothérapie usuelle seule, sur les peurs de l'activité physique et du travail et sur le statut fonctionnel chez des individus avec une lombalgie subaiguë. Cette étude pilote a utilisé un devis quasi-expérimental avec groupe contrôle non équivalent. Seize sujets ont participé à l'étude. Les mesures de résultat ont été effectuées avec l'Échelle de kinésiophobie de Tampa, le Fear-Avoidance Beliefs Questionnaire et le Roland-Morris Disability Questionnaire. Les groupes étaient comparables à l'évaluation initiale. À l'évaluation finale, l'exposition in vivo jumelée à la physiothérapie usuelle contribuait mieux à réduire les peurs de l'activité physique et du travail et à améliorer le statut fonctionnel que la physiothérapie usuelle seule. Cette étude pilote supporte la pertinence de réaliser des études avec des devis expérimentaux comportant des échantillons plus grands.

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The purpose of this study is to investigate the differences and similarities of quality of life (QoL) in American and Portuguese cancer patients with hematological malignancies as well as the robustness of the measures cross-culturally. Portuguese participants were 98 patients and 49 accompanying persons and the American participants were 55 patients and 22 accompanying persons. Fifty (Portuguese sample) to 40% (American sample) of the patients came with an accompanying person who answered the questionnaire concerning the patient's QoL. The two cultural groups were characterized in terms of QoL (measured by the SF-36 and the FLIC), social support (Social Support Scale), socio-demographic and clinical variables. Portuguese patients reported a higher QoL. However, this result could be attributable to the fact that the two cultural samples differ in socio-economic status. The measures seem to be comparable for the Portuguese and American samples, at least in what concerns reliability and concurrent validity.

Memory impairment is an outcome of Traumatic Brain Injury (TBI), and associated with lower levels of post-morbid adjustment. This research isolated the memory impairment of retrieval deficit, and examined the efficacy of cues and mnemonics in remediating the impairment. Thirty-three male and female TBI survivors, 18 to 71 years old, were pre-tested for attention (COPY), short-term memory (SD), long-term memory (LD) and recognition memory (RS) employing the Rey Osterrieth Complex Figure Test (CFT), and Subtest. Sixteen subjects demonstrating a retrieval deficit were administered the post-test, with even random assignment into four treatment conditions: a control group (CONTROL), a group administered cues (CUES), a group administered mnemonics {MNEM), and a group administered mnemonics and cues (BOTH) (n = 4). A MANOVA revealed a significant effect of TRIAL (p5.05), no significant effect of TREATMENT, and no interaction. A power analysis indicated the lack of TREATMENT effect could be the result of sample size. Post-hoc t tests revealed a difference across TRIAL for SD and LO in the two experimental conditions which utilized mnemonics. The sample was divided into two groups according to subjects' level of functioning (HIGH and LOW). A MANOVA showed main effects for LEVEL for SD and RS, for TRIAL for SD, LO, and RS, and a LEVEL by TRIAL interaction for COPY (R

The purpose of this study was to investigate the influence of gender, time since diagnosis, and the family environment on the psychosocial adaptation of cancer patients. This study was important because there is a deficit in the literature investigating the effects of the family environment on psychosocial adaptation in male and female cancer patients with diverse diagnoses. This study measured psychosocial adaptation by the patient's ability to adjust to cancer-related stressors in the areas of social relationships, involvement in health care, psychological well-being, household and work related duties, and family relationships. The family environment was measured by the patient's perceived level of cohesion, expressiveness, and conflict in the family.The study's sample consisted of 149 stage I or II cancer patients over the age of 50 with no prior cancer diagnosis, recurrence, or metastases. Participants completed a set of questionnaires, including the Psychosocial Adjustment to Illness Scale and the Family Relationship Index. The combination of gender, time since diagnosis, and the family environment, with demographic variables held constant, was significant and accounted for nearly one-third (27 %) of the variance in cancer patients' psychosocial adaptation. Results showed that the family environment is a significant predictor of psychosocial adaptation in cancer patients. Gender and time since diagnosis were not significantly related to psychosocial adaptation. Implications from this study are offered. / Department of Counseling Psychology and Guidance Services

This study examined the applicability of Mishel's model of uncertainty in illness (1990) to the adaptation process of women diagnosed with fibromyalgia. The power of uncertainty and social support to predict an uncertainty appraisal and its corresponding coping strategy utilized in this population were examined.Structural equation modeling was employed to clarify the relationships among uncertainty, social support, the appraisal of uncertainty as either danger or opportunity, and coping as either emotion-focused or problem-focused. One hundred sixty-five participants completed the Mishel Uncertainty in Illness Scale (MUIS-A), the Appraisal of Uncertainty Scale (AUS), the Jalowiec Coping Scale (JCS), and the Social Provision Scale (SPS). After an analysis of several measures of goodness-of-fit, the original model was modified based on theory, the modification indices, and a review of the maximum likelihood estimates (mle) for structural paths. These modifications resulted in a competing model. Finally, a Chi-square test was performed comparing the goodness-of-fit indices of the competing models.Results indicated that Mishel's model is a useful model within which to conceptualize the issues faced by women diagnosed with fibromyalgia. Mishel's model performed adequately; however, the overall goodness-of-fit was significantly improved by modifications which placed greater emphasis on social support. Social support and uncertainty exerted approximately equal effect on a danger appraisal and in the revised model only social support predicted an opportunity appraisal. Results also suggested that uncertainty had a direct effect on emotion-focused coping regardless of the appraisal of the uncertainty as danger or opportunity. The current study did not unequivocally support Mishel's assertion that uncertainty may be evaluated as an opportunity. Although uncertainty demonstrated a significant inverse relationship with an opportunity appraisal in the original model, in the revised model, which considered the direct effects of social support on the appraisal process, uncertainty failed to have a significant effect. Given the depth of evidence and applicability of Mishel's original model, additional research is necessary to determine whether these results are specific to the experience of fibromyalgia or perhaps social support is an under-appreciated factor in Mishel's model. Implications for treatment and directions for future research are explored. / Department of Counseling Psychology and Guidance Services

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.