| 34 on (mis)conceptions, fears, or anecdotes can change when patients learn about the effectiveness of a procedure or treatment. Some of the beliefs on the necessity of testing and expected outcomes found in our review are often indeed stalled on misconceptions, experiences of others, or fear. This highlights the importance of a shared understanding of preferences between the PwMC, SO, and GP. The GP is the key professional to help patients unravel their preferences for diagnostics and care. However, exploring patient preferences in an SDM process has been reported challenging by GPs due to competing demands and priorities or a lack of skills and tools (53). Strengths and limitations This review is strengthened by the qualitative thematic synthesis, which resulted in a comprehensive understanding of preferences influencing the decision to initiate a diagnostic trajectory for dementia. Therewith, our findings may contribute to improved SDM and more timely dementia diagnoses. Furthermore, we used a sensitive search strategy by using a broad definition of the construct preferences to increase the possibility of including all relevant studies. Last, data synthesis was performed by two researchers and validated by other researchers with broad clinical and research (including expertise on qualitative analyses and patient preferences), which enhances the credibility of our findings. We were unable to identify studies that investigated preferences before starting a diagnostic trajectory when decisions on diagnostic testing still had to be made and outcomes were unknown. The included studies asked their participants to retrospectively reflect on their preferences after decisions were made and the consequences of their decision were known. With the majority of the participants receiving a dementia diagnosis. This may have affected their recalled experience and preferences and therewith the findings of this review. Moreover, we aimed to include studies on GP’s views on their patients’ preferences to achieve data- triangulation on the involved perspectives, however, these studies were not identified in our search. Possibly due to the sensitivity of the search terms used for ‘general practitioner’. This review only includes papers on patient and SOs’ preferences and considerations for starting a diagnostic trajectory for dementia in Western countries. An explanation could be that patient preferences and involving patients in decision-making is less salient in non-Western countries and
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