Review Dialogue in Primary Care of Patients with Dementia – a Pilot Project

DOI: 10.3238/zfa.2019.0501-0505

german translation / full article

Julia Gärtner, Günther Egidi, Ottomar Bahrs

Keywords: Dementia chronic illness doctor-patient-relationship family medicine review dialogue trialogue

BackgroundIn the long-term care of chronic illness, the diagnosis of dementia is a challenge for the established doctor-patient-relationship. It also requires long-term cooperation with nursing and accompanying relatives. Individual requirements and treatment plans can be recalculated through the review dialogue (RD), a kind of consultation which is comparable to the initial interview, and which has already been approved in the long-term care of people with chronic illness.MethodsA pilot run of the RD done by the family physician (FP) in the primary care of people with dementia pursue the question to what extent the RD can be helpful. The video-documented consultation was sequentially analyzed and the reflection of the interaction jointly discussed by FP and researchers.ResultsThe RD realized as a trialoque enabled the patient’s environment to become visible. Central aspects of the relationship between patient and relative have been restaged during the conversation, and implicit, biographical topics emerge which are relevant beyond the disease context. In the joint feedback discussion on this RD in addition to the medical history experience of the FP could be explicated. This led to a deeper case-understanding by researchers and FP.ConclusionsThe concept of the RD has the potential to explore the requirements of the FP-patient-relationship regarding the dementia-typical conversational constellation of three parties (FP, patient, accompanying caregivers). Due to the impending deindividualization of people suffering from dementia in the course of the illness, it must be examined case-specifically which modifications may be required in the implementation of the RD.KeywordsDementia; review dialogue; chronic illness; doctor-patient-relationship; trialogue; family medicine

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