Decision Making for Dementia Patients

This qualitative study examines the decision-making process of family carers for people with dementia who lack capacity. It explores the facilitators and barriers to decision making and provides information for carers to overcome these barriers. The study aims to improve the understanding of decision making in dementia care.

Running head: HEALTHCARE
Topic: HEALTHCARE
Name of the Student:
Name of the University:
Author Note:

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Quantitative article: Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F.,
Price, L. L., ... & McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for
fibromyalgia: comparative effectiveness randomized controlled trial. bmj, 360, k851.
1. Did the trial address a clearly focused issue?
The study in the articular experiment has been done for determining the
effectiveness of the interventions of tai chi which has been in comparison with
aerobic exercise. The author has considered the incorporation of physical exercises as
the standard treatment method among patients with fibromyalgia and the test has been
done based on the effectiveness of the dose or the duration. Thus the authors has been
successful in clearly addressing the main research thesis of the experiment.
2. Was the assignment of patients to treatments randomised?
Patients in the give study has been randomized and been assigned to their
respective supervisors for supervised various aerobic exercise for an interval of 24
weeks almost twice every week. Moreover one out of the four Yang style usually
supervised tai chi interventions have been done along with the participants of the
studies followed for 52 weeks. The concept of adherence has been rigorously
encouraged usually in telephone and mainly by person. Randomization is important
as it helps in ensuring that randomization of statistical studies has been done and used
extensively. Randomization is important for the prevention of selection through
biasness and it helps in ensuring against any accidental bias. It helps in the
comparison of various groups and ultimately helps in the elimination of sources
through biasness for the treated assignments (Ruff et al., 2014).
3. Were all of the patients who entered the trial properly accounted for at its conclusion?

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Regarding the participation of the subjects patient supervision of Tai Chi
program though 12- 24 weeks of training. The recruitment of the participants have
been done with the use of various combinations of the advertisements as well as
through clinics which has been located in the greater Boston region.
There has been no evidence of the experiment stopped early throughout the
experiment. The adherence of the studies has been done extensively through the help
of person’s through telephone. The calculations of the sample size had been based
mainly on the results of the previous trials involving fibromyalgia. Regarding the
maintenance of the drug uses the patients has usually maintained the regular treatment
through drugs (Lavery et al., 2014).
4. Were patients, health workers and study personnel ‘blind’ to treatment?
The kind of trials done in this experiments has been a single blinded trail.
After the selection of the participants baseline assessments had been one where
assessment had been performed prior to the enrolment of the subjects. Randomization
have been done in the study. There has been the presence of arrangement based
factorial which would be mainly used for the approval of the Tai chi instructor who
have conducted every trial throughout trials. Assessments have been done and privacy
has been maintained through sealed envelopes which would be opened by the
participants mainly followed by the participants. This would be followed by the
consent which has been obtained individually by the instructor. The significance of
the single blinded trials are that they are done with the prior knowledge of the
participants and done at the knowledge of various participants through the group
membership as well a group membership regarding the identity of various results
regarding the biasness of the studies.

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5. Were the groups similar at the start of the trial
Participants has been chosen for the study inclusive of qualitative randomized
control trials. The assessments have been done on a pain index of scale of 7 and the
symptom severity has been assessed with the help of severity scale score of more
than The studies have been affected by the gender as women who had been pregnant
during the study or have involved in the planning of pregnancy during the study
period has been considered for the study. Moreover the language speaking ability
also has been a factor affecting the studies a people who had not spoken English have
been considered for the study. Moreover the selection of the subjects also has been
done on the people who have not been able to pass the mini mental examination. Thus
the selection of the participants have been based on their ability for continuing with
the routine drugs along with their visits to the physicians throughout their study. Thus,
the author has been successful in clearly mentioning the various factors which could
be instrumental in addressing study.
6. Aside from the experimental intervention, were the groups treated equally?
There has been consideration of equal treatment of the group’s throughout the
studies. Most of participants have been encouraged for receiving the Tai Chi inclusive
of the aerobic exercise protocol. Most of the Tai chi lessons have been lasting for
almost 6minutes and the aerobic exercises had been done for 1 hour for a time interval
of 12 as well 24 weeks along with the continuation of the aerobic sessions for almost
24 weeks. Attendance sheets have been usually used for monitoring the participants
and their regular attendance during the treatment sessions. Including the various
interventions, there has been continuous monitoring of the various adverse events as
well as safety protocols. Thus it has been considered necessary for the enhancement

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of a balance group regarding the studies conducted during the randomised control
trails for measuring the outcomes.
7. How large was the treatment effect?
Primary effect of outcomes have been the changes of the FIQR scores which
has been ranging from 0 to 100. The FIQR has been considered as well as rated as
validated multidimensional instrument for the measurement of the rated overall
severity consisting of carious diseases like intensity of pain, depression, fibromyalgia,
job difficulty as well as overall wellbeing. It has been also been the updated version
inclusive of the original fibromyalgia impact questionnaire has been important for the
estimation of the minimal clinical importance of the scale and its score based on
various minimal clinically importance based on the FIQ score.
Regarding the secondary outcomes they has been measured usually at the
baseline levels consisting of 12, 24 as well as 52 weeks and this has included the
global assessment which has been used for the creation of visual analogy scale.
Various scales which has been used for assessment include arthritis efficacy scale,
hospital as well as anxiety scale, along with the implementation of the Pittsburgh
sleep quality index. Thus there has been proper impact of the treatment effect which
would help in the evaluation of the assessment of the group assignment of the
participants. Various other measures affecting the impact of the survey include body
mass index, the various outcome expectations of the experiment along with the safety
as well as adherence of the factors involves in the study (Jolly et al., 2015).
8. How precise was the estimate of the treatment effect?
There has been the calculation of the sample sizes which has been based on
the results of the trial as which has been conducted previously. Fixed effect models
have been done longitudinally which has usually based on the basis of the intent to

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treat the people based on the aforementioned principle. There has been determination
of the comparative efficiency of the various five treatments along with the considered
of the baseline data. The results have usually been represented between various
groups of 95% confidence intervals. This has been usually done on the estimated
value based on eth longitudinal models.
The significance of confidence intervals in statistical studies involves the depiction of
various risks. There is inclusion of various ranges of the values which has been used
for calculations. The sample size is the main factor on which the confidence interval
depends. Usually for the statistical studies involving statistics and randomized control
trails and confidence interval of 85% have been used. Large sample sizes in surveys
and usually indicative of greater confidence and the involvement of narrow interval
on sifedence. Large confidence intervals are usually indicative of larger sample sizes.
9. Can the results be applied to the local population, or in your context?
From the various results of the statistical survey it can be understood that Tai
Chi has been proved as the usually and most effective way of non-drug intervention
for the reduction of pain in the patients suffering from myalgia. There would be
recording of the various therapeutic benefits and they would be consistent among the
instructors.
Moreover the larger sample sizes would be a proof of the various generalizability of
the experimental results which could be usually applied to the general population.
Thus the usually of the larger sample sizes would be beneficial in its implementation
in the complementary therapy which would ultimately use in complementary therapy
for reducing the change of the adverse effects of the various medications used for the
treatment of the patients suffering for fibromyalgia.
10. Were all clinically important outcomes considered?

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According to the specifications given by the author, there has been equal
consideration of the clinically important outcomes in the study which has been
inclusive of occurrence of adverse anxiety, drug reactions along with the prevalence
of pain and depression. Moreover the factors affecting the sleep quality and the
mental component has also been considered. Thus the improvements are tailored and
in per alignment with the baseline data and the collection is done prior to the
administration for intervention.
11. Are the benefits worth the harms and costs?
Tai chi has been considered as better methods of the inclusion of various
complementary exercise and therapeutic processes which has not only been used of
the treatment of pain in diseases like fibromyalgia. The benefits of the exercise has
been involved in the physical and mental well-being of the people. Initial costs have
been much more than the benefits involving the Tai chi Instructor but there has been
subsequent reductions in the medicines as well as hospital related costs (Wang et al.,
2018).
Qualitative article: Livingston, G., Leavey, G., Manela, M., Livingston, D., Rait, G.,
Sampson, E., ... & Cooper, C. (2010). Making decisions for people with dementia who lack
capacity: qualitative study of family carers in UK. Bmj, 341, c4184.
1. Was there a clear statement of the aims of the research?
The research studies done here has been the identification of various decision making
processes made by family carers. This identification has been aimed on behalf of the people

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suffering usually from dementia and the various facilitators as well as barriers to the decision
making process have been determined. The author has finally aimed at the production of
information inclusive of the family carers which would be involved about overcoming the
barriers. Thus aims of the research study has been clearly justified through the
implementation of a qualitative focus group study revolving around the complex decision
making processes though individual interviews (Meriam & Grainer, 2019).
2. Is a qualitative methodology appropriate?
The qualitative process which has been taken in the study has been used in throwing
light on the process of complex decision making process which would involve the care given
to the heath carers giving care to people who have been suffering from dementia. The
research gap have been overcome by the author with proper justifications regarding the
implementation of medical conditions during end of life. The various research methodologies
have been conducted in the phases which is inclusive of the generation of various common
areas among the family carers through initial focus group studies. In the second phase of the
interview there has been individual interviews regarding the concepts of the family carers.
However, statistical analysis of the data has been through the study of socio demographic
variables through the use of various software programs management. Thus the qualitative
method taken by the author has been appropriate.
3. Was the research design appropriate to address the aims of the research?
The various research design of the articular experiment has been done in three ways
inclusive of data collection followed by data measurement and data analysis. The data
collection process has been one in two ways, initially through focus group study for the
generation of the areas where family carers would make decisions which has been on behalf
of recipients of care. The second phase has been during in-depth individual interviews about
carers which have decision making throughout their lives. Selection of the sample size has

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been based on the people who are family caregivers and would be answering on the behalf of
dementia patients. For covering various range of experiences, the sample has been selected
with diverse socioeconomic characteristics. These methods have been followed by data
measurement where the responses during the interview has been measured, data analysis
studies has been done after recording the interviews and transcribing them verbatim.
Anonymous participation has been used in the experiment.
4. Was the recruitment strategy appropriate to the aims of the research?
In the following experiment conducted by the authors there has been proper
justification of the settings where the people chosen from the hospital in the inner as well as
outer areas of London has been selected. The participation by the subjects has been justified
by the author inclusive of for general activist, specialist neurodementia clinic along with
community clinics. No such mention about the permission taken for the participants has been
mentioned. There has been clear specification of the primary as well as secondary care in the
different phases of the study. The voluntary participation of the people and the justification
for the people who have not participated in the study has been not been specified.
5. Was the data collected in a way that addressed the research issue?
The settings of the experiment has been among the participants against a hospital
setting in the areas of London. Thus the setting for the experiment has been justified. This
has been a focus group study inclusive of the qualitative analysis of the decision making
process of the care givers. The author have justified the methods of the study inclusive of the
survey including the two phases of focus group study and discussion of interviews for
decision making process the procedure of the interviews and participation of the subjects
have been well justified by the author. The analysis process have also been well detailed and
justified by the author however there have been no mention of voluntary participation.
6. Has the relationship between researcher and participants been adequately considered?

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There has been a method of data collection from the research participants in the
qualitative research inclusive of focus studies. Various information where participants which
has been used in proper research settings which has been dependent on the relationship
between the researcher and research. There has been negotiation of rules in the research
agenda inclusive of changes in experience. This exchange has been done in the inferior and
superior positions emerging as intertwined central themes in the discussions. There have been
qualitative researches which have led to power relation confirming the variability of data in
various ways. There is proper communication of the caregivers’ days after information is sent
asking the permission of the participants. Their consent and the discussion along with
voluntary participation proves the validity of research.
7. Have ethical issues been taken into consideration?
Ethical consideration is important for the validity as well as reliability of the primary
research which has been inclusive of insurance regarding the prevention of any act of
violation as well as any issues regarding the protection regulation of the individuals taking
part in a study. They are important in avoiding or resolving ethical dilemmas. This might
occur during planning and the conduction of the primary research inclusive of methods like
surveys, interview and surveys. The research and development committee have already
approved the research ethics of the study. Any other additional data has not been given during
the study. Thus all the major ethical aspects of the study has been considered.
8. Was the data analysis sufficiently rigorous?
Rigor in an experimental study is defined as the quality of research process. Rigor has
been found to be related to the development of trustworthy findings. In the given experiment
there has been digital recordings of the interview along with their transcription verbatim.
Moreover useful information have been removed for preserving the anonymity. The
researcher have used qualitative research program Atlas.ti.5.2 for the development of

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management Thus there has no attachment of the coding section which would be considered
insufficient for the analysis of rigor.
9. Is there a clear statement of findings?
A research statement is defined as the main summarization of the research
achievements including proposal for upcoming research. Thus all the necessary information
inclusive of theorists have been recorded in very brief presentation. According to the findings
as of the research statement as funded by BUPA foundation. All the researchers in the study
are independent of finders. Thereby from the study it can be understood that there has been a
clear justification of the findings as there is absence of holistic presentation. There is a clear
portrayal of the research accomplishment of research of research. This would help in meeting
the research objectives. The finding statement is not adequate.
10. How valuable is the research?
The main purpose of the research has been identification of the complex decision
making processes which has been given by the health carers on behalf of the patients
suffering from dementia. Thus through the qualitative study focusing on the decision making
ability of the caregivers, the existing decision making process in the backdrop of healthcare
has been discussed. The author has been successful in consideration of the findings of the
decision makers in relevance to the current healthcare practice. The author have also stressed
on the importance of family conflict on the difficulty level of decision making process. Thus
the concept of family consulting options has not proved enough for the benefits of the
caregivers. The author has clearly justified the unanswered questions and limitations of the
study. Moreover, the unanswered questions have been implying further development in the
research world. Thus the research findings have been valuable and have successfully
addressed the concern regarding the research question.

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