Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2018

Open Access 01-12-2018 | Protocol

General practitioners’ knowledge, attitudes and experiences of managing behavioural and psychological symptoms of dementia: protocol of a mixed methods systematic review and meta-ethnography

Authors: Aisling A. Jennings, Tony Foley, Kieran A. Walsh, Alice Coffey, John P. Browne, Colin P. Bradley

Published in: Systematic Reviews | Issue 1/2018

Login to get access

Abstract

Background

In the context of rising dementia prevalence, the workload of general practitioners (GPs) in dementia care is set to increase. However, there are many aspects of dementia care that GPs find challenging. Behavioural and psychological symptoms of dementia (BPSD) affect the majority of people with dementia and is an aspect of dementia care that GPs find particularly difficult to manage. The aim of this mixed methods systematic review is to undertake a synthesis of qualitative and quantitative studies on GPs’ knowledge, attitudes and experiences of managing BPSD.

Methods

Seven electronic bibliographic databases will be searched from inception to present. All qualitative or quantitative studies that explore the knowledge, attitude or experiences of GPs towards the management of BPSD in community and/or residential settings will be eligible for inclusion. A meta-ethnography will be conducted to synthesise included studies. Primary outcome measures will include GPs’ experiences of managing BPSD, GPs’ knowledge of BPSD and their attitude to different approaches to the management of BPSD, in particular their attitude to non-pharmacological approaches. All included papers will be independently assessed for methodological validity by two reviewers using the following tools: the Joanna Briggs Institute checklist for qualitative research, the Effective Public Health Practice Project (EPHPP) tool for intervention studies and the National Institute of Health (NIH) quality assessment tool for observational and analytical cross-sectional studies. As there is no agreed quality assessment tool for descriptive cross-sectional studies, an original tool will be developed. Two independent reviewers will apply the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) tool to the review findings. The results will be reported in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement.

Discussion

This study will be the first systematic review that synthesises the existing literature of GPs’ knowledge, attitudes and experiences of managing BPSD in community and residential care. This review will improve our understanding of GPs’ perspectives on the management of BPSD, and the results will be used to inform the development of an intervention to improve the management of BPSD in general practice.

Systematic review registration

PROSPERO CRD42017054916.
Appendix
Available only for authorised users
Literature
1.
Downs MG. The role of general practice and the primary care team in dementia diagnosis and management. International Journal of Geriatric Psychiatry. 1996;11:937–42.CrossRef
2.
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–734.
3.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2013;9:63–75.CrossRef
4.
Department of Health. Living well with dementia: UK National Dementia Strategy. Leeds: Department of Health and Social Care; 2009. p. 1-102.
5.
Department of Health. The Irish national dementia strategy. Dublin: The Department of Health; 2014. p. 1-40.
6.
7.
Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing. 2004;33:461–7.
8.
Foley T, Boyle S, Jennings A, Smithson WH. “We’re certainly not in our comfort zone”: a qualitative study of GPs’ dementia-care educational needs. BMC Fam Pract. 2017;18:66.CrossRefPubMedPubMedCentral
9.
Tang EYH, Birdi R, Robinson L. Attitudes to diagnosis and management in dementia care: views of future general practitioners. Int Psychogeriatr. 2016;28:1–6.
10.
11.
Stewart TV, Loskutova N, Galliher JM, Warshaw GA, Coombs LJ, Staton EW, Huff JM, Pace WD. Practice patterns, beliefs, and perceived barriers to care regarding dementia: a report from the American Academy of Family Physicians (AAFP) National Research Network. J Am Board Fam Med. 2014;27:275–83.CrossRefPubMed
12.
Lawlor B. Managing behavioural and psychological symptoms in dementia. Br J Psychiatry. 2002;181:463–5.CrossRefPubMed
13.
Savva GM, Zaccai J, Matthews FE, Davidson JE, McKeith I, Brayne C. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry. 2009;194:212–19.
14.
Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschanz JT. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008;23:170–7.CrossRefPubMedPubMedCentral
15.
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288:1475–83.CrossRefPubMed
16.
Steinberg M, Corcoran C, Tschanz JT, Huber C, Welsh-Bohmer K, Norton MC, Zandi P, Breitner JC, Steffens DC, Lyketsos CG. Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2006;21:824–30.CrossRefPubMed
17.
Jeste DV, Blazer D, Casey D, Meeks T, Salzman C, Schneider L, Tariot P, Yaffe K. ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology. 2008;33:957–70.CrossRefPubMed
18.
Brodaty H, Connors MH, Xu J, Woodward M, Ames D. Predictors of institutionalization in dementia: a three year longitudinal study. J Alzheimers Dis. 2014;40:221–6.PubMed
19.
Wancata J, Windhaber J, Krautgartner M, Alexandrowicz R. The consequences of non-cognitive symptoms of dementia in medical hospital departments. Int J Psychiatry Med. 2003;33:257–71.CrossRefPubMed
20.
O’Donnell BF, Drachman DA, Barnes HJ, Peterson KE, Swearer JM, Lew RA. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992;5:45–52.PubMed
21.
Ornstein K, Gaugler JE. The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr. 2012;24:1536–52.CrossRefPubMedPubMedCentral
22.
Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62:762–9.CrossRefPubMedPubMedCentral
23.
Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry. 2006;14:191–210.CrossRefPubMed
24.
Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, Kales HC. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72:438–45.CrossRefPubMedPubMedCentral
25.
Ballard C, Creese B, Corbett A, Aarsland D. Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opin Drug Saf. 2011;10:35–43.CrossRefPubMed
26.
27.
28.
NICE: Dementia: supporting people with dementia and their carers in health and dementia and their carers in health and social care. 2016.
29.
30.
Buhagiar K, Afzal N, Cosgrave M. Behavioural and psychological symptoms of dementia in primary care: a survey of general practitioners in Ireland. Ment Health Fam Med. 2011;8:227–34.PubMedPubMedCentral
31.
Teel CS. Rural practitioners’ experiences in dementia diagnosis and treatment. Aging Ment Health. 2004;8:422–9.CrossRefPubMed
32.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedPubMedCentral
33.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.CrossRefPubMedPubMedCentral
34.
Downs M, Cook A, Rae C, Collins KE. Caring for patients with dementia: The GP perspective. Aging Mental health. 2000;4(4):301–4.
35.
Mavrodaris A, Philp I. Reducing antipsychotic prescriptions in primary care: a healthcare perspective. Journal of Public Mental Health. 2013;12:32–42.CrossRef
36.
Hinton L, Franz CE, Reddy G, Flores Y, Kravitz RL, Barker JC. Practice constraints, behavioral problems, and dementia care: primary care physicians’ perspectives. J Gen Intern Med. 2007;22:1487–92.CrossRefPubMedPubMedCentral
37.
38.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.CrossRef
39.
40.
Voils CI, Sandelowski M, Barroso J, Hasselblad V. Making sense of qualitative and quantitative findings in mixed research synthesis studies. Field Methods. 2008;20:3–25.CrossRefPubMedPubMedCentral
41.
Feast A, Orrell M, Charlesworth G, Melunsky N, Poland F, Moniz-Cook E. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. Br J Psychiatry. 2016;208:429–34.CrossRefPubMedPubMedCentral
42.
Barley EA, Murray J, Walters P, Tylee A. Managing depression in primary care: a meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators. BMC Fam Pract. 2011;12:47.CrossRefPubMedPubMedCentral
43.
Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. Newbury Park: SAGE; 1988.CrossRef
44.
45.
Thorne S. Metasynthetic madness: what kind of monster have we created? Qual Health Res. 2017;27:3–12.CrossRefPubMed
46.
Sandelowski M, Docherty S, Emden C. Focus on qualitative methods. Qualitative metasynthesis: issues and techniques. Res Nurs Health. 1997;20:365–71.CrossRefPubMed
47.
Arman M, Rehnsfeldt A. The hidden suffering among breast cancer patients: a qualitative metasynthesis. Qual Health Res. 2003;13:510–27.CrossRefPubMed
48.
Walsh D, Downe S. Meta-synthesis method for qualitative research: a literature review. J Adv Nurs. 2005;50:204–11.
49.
Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181.CrossRefPubMedPubMedCentral
50.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.CrossRefPubMed
51.
Sandelowski M, Leeman J, Knafl K, Crandell JL. Text-in-context: a method for extracting findings in mixed-methods mixed research synthesis studies. J Adv Nurs. 2013;69:1428–37.
52.
Atkins S, Lewin S, Smith H, Engel M, Fretheim A, Volmink J. Conducting a meta-ethnography of qualitative literature: lessons learnt. BMC Med Res Methodol. 2008;8:21.CrossRefPubMedPubMedCentral
53.
Walsh KA, Dennehy R, Sinnott C, Browne J, Byrne S, McSharry J, Coughlan E, Timmons S. Influences on decision-making regarding antipsychotic prescribing in nursing home residents with dementia: a systematic review and synthesis of qualitative evidence. J Am Med Dir Assoc. 2017;18:897.CrossRefPubMed
54.
Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gulmezoglu M, Noyes J, Booth A, Garside R, Rashidian A. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med. 2015;12:e1001895.CrossRefPubMedPubMedCentral
55.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
56.
Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid-Based Nurs. 2004;1:176–84.CrossRefPubMed
57.
NIH: National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. 2014.
58.
Saab MM, Landers M, Hegarty J. Testicular cancer awareness and screening practices: a systematic review. Oncol Nurs Forum. 2016;43:E8–23.CrossRefPubMed
59.
60.
Assessment of qualitative research. In: Sytematic reviews: CRD’s guidance for undertaking reviews in health care; 2009.
61.
Hannes K. Chapter 4: critical appraisal of qualitative research. In: BA NJ, Hannes K, Harden A, Harris J, Lewin S, Lockwood C, Cochrane Collaboration Qualitative Methods Group, editors. Supplementary guidance for inclusion of qualitative research in Cochrane Systematic Reviews of Interventions; 2011.
62.
Dixon-Woods M, Booth A, Sutton AJ. Synthesizing qualitative research: a review of published reports. Qual Res. 2007;7:375–422.CrossRef
63.
Dixon-Woods M, Shaw RL, Agarwal S, Smith JA. The problem of appraising qualitative research. Qual Saf Health Care. 2004;13:223–5.
64.
Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies. BMC Med Res Methodol. 2014;14:80.CrossRefPubMedPubMedCentral
65.
Mays N, Pope C. Qualitative research in health care: assessing quality in qualitative research. Br Med J. 2000;320:50–2.
66.
JBI: The Joanna Briggs Institute Critical Appraisal tools: checklist for qualitative research. 2016.
Metadata
Title
General practitioners’ knowledge, attitudes and experiences of managing behavioural and psychological symptoms of dementia: protocol of a mixed methods systematic review and meta-ethnography
Authors
Aisling A. Jennings
Tony Foley
Kieran A. Walsh
Alice Coffey
John P. Browne
Colin P. Bradley
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2018
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-018-0732-7

Other articles of this Issue 1/2018

Systematic Reviews 1/2018 Go to the issue

Protocol

Life satisfaction and positive and negative feelings of workers: a systematic review protocol

Protocol

Experiences of aging in place in the United States: protocol for a systematic review and meta-ethnography of qualitative studies

Protocol

Nanomedicine for drug delivery in South Africa: a protocol for systematic review

Systematic review update

Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature

Protocol

Evidence of the factors that influence the utilisation of Kangaroo Mother Care by parents with low-birth-weight infants in low- and middle-income countries (LMICs): a scoping review protocol

Protocol

Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review