Health care experiences of people with dementia and their caregivers: a meta-ethnographic analysis of qualitative studies

Methods: We searched the electronic data- bases MEDLINE, Embase, PsychINFO and CINAHL to identify relevant articles. We extracted key study characteristics and meth- ods from the included studies. We also extracted direct quotes from the primary stud- ies, along with the interpretations provided by authors of the studies. We used meta- ethnography to synthesize the extracted information into an overall framework. We evaluated the quality of the primary studies using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: In total, 46 studies met our inclusion criteria; these involved 1866 people with dementia and their caregivers. We identified 5 major themes: seeking a diagnosis; accessing supports and services; addressing information needs; disease management; and communica- tion and attitudes of health care providers. We conceptualized the health care experience as progressing through phases of seeking understanding and information, identifying the problem, role transitions following diag- nosis and living with change. Interpretation: The health care experience of people with dementia and their caregivers is a complex and dynamic process, which could be improved for many people. Understanding these experiences provides insight into poten- tial gaps in existing health services. Modifying existing services or implementing new models of care to address these gaps may lead to improved outcomes for people with dementia and their caregivers.