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Family physicians and dementia in Canada

Part 2. Understanding the challenges of dementia care

Malini Persaud, MN PhD
Doctoral candidate in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto at the time of the study

Neil Drummond, PhD HonMFPHM(UK)
Associate Professor and Director of Research in the Department of Family Medicine at the University of Calgary in Alberta

Carole A. Cohen, MD FRCPC
Associate Professor in the Department of Psychiatry at the University of Toronto

James L. Silvius, MD FRCPC
Regional Chief for the Division of Geriatric Medicine at the University of Calgary

Karen Seigel, MD CCFP
Family physician in Calgary and participates in research with the Department of Family Medicine at the University of Calgary

Gary R. Hollingworth, MD CCFP FCFP
Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario

William B. Dalziel, MD FRCPC
Chief of the Ottawa Regional Geriatric Assessment Program

Correspondence: Dr Nicholas Pimlott, Women’s College Hospital, 60 Grosvenor St, Toronto, ON M5S 1B6; telephone 416 323-6400, extension 4581; fax 416 323-6351; e-mailnick.pimlott{at}utoronto.ca

OBJECTIVE To explore the challenges Canadian family physicians face in providing dementia care.

DESIGN Qualitative study using focus groups.

SETTING  Academic family practice clinics in Calgary, Alta, Ottawa, Ont, and Toronto, Ont.

PARTICIPANTS  Eighteen family physicians.

METHODS We conducted 4 qualitative focus groups of 4 to 6 family physicians whose practices we had audited in a previous study. Focus group transcripts were analyzed using the principles of thematic analysis.

MAIN FINDINGS  Five major themes related to the provision of dementia care by family physicians emerged: 1) diagnostic uncertainty; 2) the complexity of dementia; 3) time as a paradox in the provision of dementia care; 4) the importance of patients’ families; 5) and familiarity with patients. Participants expressed uncertainty about diagnosing dementia and a strong need for expert verification of diagnoses owing to the complexity of dementia. Time, patients’ family members, and familiarity with patients were seen as both barriers and enablers in the provision of dementia care.

CONCLUSION Family physicians face many challenges in providing dementia care. The results of this study and the views of family physicians should be considered in the development and dissemination of future dementia guidelines, as well as by specialist colleagues, policy makers, and those involved in developing continuing physician education about dementia.