M Gordon1, D Goldstein. 1. Department of Geriatrics at Mount Sinai Hospital, Medical Services and Head of Geriatrics, Internal Medicine at the Baycrest Centre for Geriatric Care in Toronto, Ont. mgordon@baycrest.org
Abstract
OBJECTIVE: To evaluate reasons for telling or not telling patients about a diagnosis of Alzheimer's disease and to assess the effect of such a decision on patients, families, physicians, and the health care system. QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 1999 using the key words "Alzheimer's disease" or "dementia" and "truth disclosure" or "attitude to health." There were no randomized controlled trials (level I evidence) in the literature. Articles identified provided level II evidence (case-controlled and cross-sectional studies) or level III evidence (expert opinion). All articles identified were chosen for this study. MAIN MESSAGE: In attempting to determine whether or not to communicate a diagnosis of Alzheimer's disease, physicians face a predicament: the desire to communicate honestly and directly with a patient is sometimes at variance with the equally compelling desire to concur with the patient's family's reluctance to disclose the diagnosis. Most Alzheimer's patients should be told of their diagnosis, but the timing of the discussion and the way it occurs are crucial to a good outcome. Most patients accept the information without a catastrophic response. Physicians must gain support from patients' families because it could take time for them to accept disclosure of what is perceived as a "hopeless" diagnosis. CONCLUSION: We must continue to support Alzheimer's patients and promote hope.
OBJECTIVE: To evaluate reasons for telling or not telling patients about a diagnosis of Alzheimer's disease and to assess the effect of such a decision on patients, families, physicians, and the health care system. QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 1999 using the key words "Alzheimer's disease" or "dementia" and "truth disclosure" or "attitude to health." There were no randomized controlled trials (level I evidence) in the literature. Articles identified provided level II evidence (case-controlled and cross-sectional studies) or level III evidence (expert opinion). All articles identified were chosen for this study. MAIN MESSAGE: In attempting to determine whether or not to communicate a diagnosis of Alzheimer's disease, physicians face a predicament: the desire to communicate honestly and directly with a patient is sometimes at variance with the equally compelling desire to concur with the patient's family's reluctance to disclose the diagnosis. Most Alzheimer'spatients should be told of their diagnosis, but the timing of the discussion and the way it occurs are crucial to a good outcome. Most patients accept the information without a catastrophic response. Physicians must gain support from patients' families because it could take time for them to accept disclosure of what is perceived as a "hopeless" diagnosis. CONCLUSION: We must continue to support Alzheimer'spatients and promote hope.