PERSON-CENTRED COMMUNICATION AND THE CARE OF PEOPLE WITH DEMENTIA: EXPLORING THE PERSPECTIVES OF MEDICAL STUDENTS IN THE UNITED KINGDOM AND MALAYSIA

Abstract

Person-centred communication (PCC) is the approach to interaction most favoured in health policy and educational guidance over recent years in the care of people with dementia (PWD), particularly in the global ‘west’. It is, however, under-theorised, and the extent to which it is applicable to care in different contexts is underexplored. This international study investigated the views of medical students regarding the applicability of a new author-developed PCC model – the Dementia Model of Effective Communication (DEMEC)- to the care of PWD. Our specific aim was to provide internationally and transculturally relevant information comparing the views of undergraduates in different year groups, and in two culturally-contrastive national locations. The study had a mixed methods design, triangulating quantitative survey data with qualitative interview data. Students in the UK and Malaysia (N = 618), following the same undergraduate medical education curriculum, completed a Dementia Communication Questionnaire: subgroups of students then took part in focus groups (N = 39) or in individual interviews (N = 10) in each location to discuss issues arising. Findings indicated a general acceptance, across the year groups and locations, of the appropriateness and effectiveness of most aspects of PCC as articlated in DEMEC, but also highlighted awareness of some of the challenges of applying this approach to real-life, real-time care. Complexities were identified by students regarding certain issues, including the acceptability of deception and the value and ethics of speaking to family members first. Differences emerged between participants in the two locations about these two issues, as well as on appropriate terminology to designate PWD. Findings, while generally supportive of the applicability and relevance of a PCC model, also point up some of the possible difficulties of the application of PCC in different cultural environments. We detail possible reasons for medical students’ uncertainties, and the implications of these findings for medical education and care practice internationally, and for interaction theory related to communication and appropriate care for PWD.