51³Ô¹Ï

Topic

Healthcare Professionals’ Experiences with Treatment Decision Making When Older People are Living with Neurocognitive Disorders (MCI-Dementia) and Comorbid Conditions

School of Nursing

Date & location

• Monday, July 7, 2025
• 9:30 A.M.
• Virtual Defence

Examining Committee

Supervisory Committee

• Dr. Esther Sangster-Gormley, School of Nursing, 51³Ô¹Ï (Supervisor)
• Dr. Karen MacKinnon, School of Nursing, UVic (Member)
• Dr. Lorelei Newton, School of Nursing, UVic (Member)
• Dr. Jayna Holroyd-Leduc, Department of Medicine, University of Calgary (Outside Member)

External Examiner

• Dr. Mona Sawhney, School of Nursing, Queen's University

Chair of Oral Examination

• Dr. Alison Murray, Department of Anthropology, UVic

Abstract

Treatment decision making is a core component of healthcare professionals’ practice. It is the point at which healthcare professionals draw on their clinical judgement, knowledge, past experiences, and perceptions to make decisions that influence the treatments and care of their patients. My experiences trying to access equitable care and to determine what was in the best interest of older people living with a neurocognitive disorder and other comorbid conditions have challenged my own treatment decision making. Research has shown high mortality rates, patterns of under- and over-treatment, unmet needs, and fluctuating levels of care satisfaction among this population.

In my recognition of this complexity the purpose of this dissertation was to explore and understand healthcare professionals’ experiences and resulting perceptions when working with older people. The following question guided this dissertation: What are healthcare professionals’ experiences and perceptions of treatment decision making when older people are living with memory loss secondary to a neurocognitive disorder who also experience other health problems?

To answer this question, I employed two methods: a Joanna Briggs Institute meta-aggregative qualitative systematic review and a subsequent qualitative study informed by an interpretive description approach. I utilized the Joanna Briggs Institute meta-aggregative review to synthesize what is known about this phenomenon. This method provided a way to review the evidence pertaining to all healthcare professionals’ treatment decision making affecting a group of older people living with symptoms of memory loss secondary to a neurocognitive disorder (mild cognitive impairment or dementia). This comprehensive review informed the second phase of the study focused on exploring nurse practitioners’ decisions affecting a subset population of older people living with a neurocognitive disorder and cancer.

The knowledge gained from the systematic review and qualitative study provided insights into treatment decision making processes, challenges, factors influencing decisions, and strategies that healthcare professionals used when making decisions. A series of recommendations for practice have resulted, and it is my hope that they will ultimately improve the experiences of older people and their families living with a neurocognitive disorder.