2 | 35 dementia is still largely associated with stigma (54, 55). This stresses the need for future research on this topic. Implications for practice and suggestions for further research This review gives insight into the considerations on deciding on starting a diagnostic trajectory for dementia, which may contribute to more timely diagnoses and SDM in three ways: (1) GPs could use the identified views on diagnostic testing to start an SDM process. For example by asking their patients and/or their SOs about what they expect the outcome of diagnostic testing will bring them. (2) The variety of presented considerations and factors around deciding on diagnostic testing for dementia, could create awareness among GPs that each patient and/or SO can have different views on diagnostic testing that are worth exploring. (3) Barriers mentioned by GPs to discuss starting a diagnostic trajectory for dementia may be solved, when this knowledge is implemented in HCPs’ (communication) training (20-22). Patient decision aids like the one being developed in the S-DeciDeD study can also support SDM in general practice (56). Moreover, despite our attempt to understand the process of preference formation, we were only able to include studies that described patients’ retrospective views on the decision-making process for starting a diagnostic trajectory. Future research should attempt to prospectively include patients and their SOs to assess their preferences before the outcomes of their decisions are known. Conclusions The different considerations of PwMCs and SOs in deciding on pursuing a diagnostic trajectory for dementia identified, emphasize the relevance of pursuing a timely dementia diagnosis. Individuals have different needs and values, which should be explored together with an HCP in an SDM process. In essence, when PwMCs and SOs are deciding on whether or not to pursue a diagnostic trajectory for dementia, they are driven by the need to do something to decrease feelings of uncertainty and are led by beliefs on the necessity and expected outcomes of a diagnostic trajectory. These views are affected by whether symptoms are normalized or validated, the support or wishes of their social network, interactions with HCPs, and societal factors.
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