Maud Hevink

2 | 31 ‘The family doctor said ‘‘no’’ in the beginning, he did not think of it. He felt I might be too sensitive’ (45). However, a strong drive to reduce uncertainty on the cause of the symptoms led some PwMCs to seek a second opinion (38). When the HCP took concerns about memory complaints seriously, PwMCs’ and SOs’ beliefs on the necessity of starting a diagnostic trajectory were confirmed and diagnostic testing was pursued (38, 46). Moreover, when HCPs presented decisions implicitly (instead of an option for which patients’ preferences mattered) beliefs on the necessity of starting a diagnostic trajectory could be heightened or weakened (depending on the patients’ initial beliefs) (44). The ability of the PwMC and SO to communicate their concerns, could in turn, impact the HCPs reaction and therewith PwMCs’ and SOs’ views on starting a diagnostic trajectory (45). Also, the level of trust in the HCP and their perceived qualifications (e.g. age, education level) influenced whether their advice impacted views on starting a diagnostic trajectory (38, 45). Theme 5: Health status of the PwMC Beliefs on the necessity of starting a diagnostic trajectory could be affected by heightened or diminished awareness of symptoms due to the health status of the PwMC. PwMCs with a family history of dementia were more inclined to believe diagnostic testing is necessary in the presence of minor memory complaints (41). ‘It runs in the family, and that is another reason why I decided relatively quickly to do something.’ (41) Also, comorbidities often provide a distraction from the memory complaints, which can affect the belief of PwMCs, SOs, and HCPs that diagnostic testing is not yet needed (40, 45). However, the need for medical help for physical complaints can also lead to HCPs to notice memory complaints, which in turn affect the belief that a diagnostic trajectory is necessary (40, 46). In addition, a crisis (e.g. a fall or traffic accident) often strengthens the belief that diagnostic testing is necessary (40, 43). Other health-related factors can accelerate or decelerate the decision to start a diagnostic trajectory, sometimes regardless of the PwMCs and SOs’ initial views. For example, impaired mobility of the PwMC was a reason to defer a diagnostic trajectory (39).

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