Lassa, S., Burton, C. orcid.org/0000-0003-0233-2431 and Dickson, J.M. orcid.org/0000-0002-1361-2714 (2025) GPs’ experience of difficult decisions in people with dementia who have an acute illness: a qualitative, semi-structured interview study. BJGP Open, 9 (1). 0074. ISSN 2398-3795
Abstract
Background
GPs 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.
Aim
We aimed to explore how GPs made decisions about acute illness in people with dementia using a micropolitics approach.
Design & setting
Qualitative, semi-structured interviews with 13 GPs with a range of years of experience working in South Yorkshire, UK.
Method
Interviews 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.
Results
The 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.
Conclusion
GPs 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.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2025, The Authors. This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/) |
Keywords: | Acute disease; Decisions; Dementia; General practitioners; Primary healthcare |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 03 Jul 2025 11:10 |
Last Modified: | 03 Jul 2025 11:10 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Refereed: | Yes |
Identification Number: | 10.3399/bjgpo.2024.0074 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:228722 |