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Janes, M 
ORCID: https://orcid.org/0000-0001-5249-5752,
2024.
Optimising diagnostic pathways for dementia care: the implications of pre-assessment counselling.
PhD, Nottingham Trent University.
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Abstract
As the global prevalence of dementia rises, driven by ageing populations and increased life expectancies, the need for effective diagnostic pathways has become a public health concern. This thesis explores the role of pre-assessment counselling (PAC) in optimising the experience for people with dementia and their carers. PAC is an intervention delivered following a general practitioner (GP) referral before undergoing a formal clinical assessment for dementia from specialist dementia healthcare practitioners from memory assessment services. It provides tailored support through education and information, emotional assistance and guidance to enable people with dementia and those who care for them to navigate the diagnostic process with increased confidence and an understanding of what to expect from their dementia journey.
The research within this thesis incorporates insights from clinical psychology, neuropsychology and health psychology. It comprises several methodological approaches, including a systematic literature review, a summative service evaluation, qualitative semi-structured interviews with healthcare professionals, quantifying feelings of fear of dementia, depression, anxiety and stress in people with dementia before and after receiving PAC, and quantitively measuring the comparative benefits of PAC in carers who had received the intervention with those who had not.
The systematic literature review synthesises the empirical evidence of PAC used within dementia care pathways, noting that it enables psychological adjustment in people with dementia towards a potential diagnosis, that it supports healthcare professionals with quality service provision, and it helps to bring family members into discussions to assist them in supporting their loved ones. The summative service evaluation indicates that PAC aids in timely diagnoses through information and support provision to people with dementia so that they can make informed decisions about their care. The qualitative study with healthcare professionals reveals key benefits of PAC where people with dementia are placed centrally in their diagnosis journey, candid conversations help to build strong therapeutic alliances, and people with dementia learn through PAC delivery to accept that a diagnosis of dementia does not define them or their lives. The quantitative study involving people with dementia demonstrates how PAC significantly reduces stress following the intervention. In the mixed-methods study, the quantitative component shows that PAC benefits carers of people with dementia, significantly improving experiences of the initial appointment in the memory assessment service at the start of their dementia journey and increased levels of well-being post-diagnosis when compared with those who had not received PAC. The qualitative component echoed the measured outcomes and provided further insight by adding context.
These findings lead this thesis to recommend the integration of PAC into usual care provisions within dementia care pathways, owing to its ability to enhance person-centred care and significantly improve psychological outcomes for people with dementia and their carers. It recommends further research to determine the long-term effects of PAC across diverse groups and the requirement for a standardised approach.
| Item Type: | Thesis |
|---|---|
| Creators: | Janes, M. |
| Contributors: | Name Role NTU ID ORCID |
| Date: | December 2024 |
| Divisions: | Schools > School of Social Sciences |
| Record created by: | Jeremy Silvester |
| Date Added: | 17 Jul 2025 10:19 |
| Last Modified: | 17 Jul 2025 10:19 |
| URI: | https://irep.ntu.ac.uk/id/eprint/53973 |
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