ArticleBJGP open2025
GPs' experience of difficult decisions in people with dementia who have an acute illness: a qualitative, semi-structured interview study.
Article in BJGP open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
backgroundGPs are often required to make decisions about the management of acute illness in people living with dementia. These decisions are often complex and involve multiple informants.
aimWe aimed to explore how GPs made decisions about acute illness in people with dementia using a micropolitics approach. DESIGN &
settingQualitative, semi-structured interviews with 13 GPs with a range of years of experience working in South Yorkshire, UK.
methodInterviews were conducted by phone. Interviews focused on GPs' accounts to reflect their own perceptions and choices as portrayed to the interviewer. The analysis used the lens of micropolitics in the analysis and interpretation of the themes, with a focus on decisions between GP, patient, family and carers, and other health and social care providers about the management of acute illness in a person with dementia.
resultsThe results showed that GPs act as street-level bureaucrats while carrying out their role, using discretion during decision-making in an environment characterised by uncertainties and work pressures. In addition, GPs use the 'soft power' skills of diplomacy, such as negotiation, persuasion, and engagement, in navigating difficult decision-making situations, while building relationships and partnerships with various actors in the health system.
conclusionGPs possess and express power, and influence decision-making in people living with dementia when navigating biomedical, social, and psychological factors. This power comes in the form of soft power (street-level diplomacy) and the more formal power of street-level bureaucracy.
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