Understanding Therapeutic Lying In The Care Of A Person with Dementia: An Evolutionary Concept Analysis

Background Therapeutic lying, described as any verbal or non-verbal behaviour or communication that involves the manipulation of information has been shown to be pervasive in dementia care. However, its theoretical foundation is difficult to underpin and appears to have evolved through practice without a clear definition. The aim of this study is to establish conceptual clarity around the concept of therapeutic lying in the care of a person with dementia. Methods Rodgers’ evolutionary concept analysis was used to focus on the contextual qualities of therapeutic lying. This dispositional view recognises that concepts are fluid in nature. The analysis involves deconstructing the concept into surrogate terms, attributes, antecedents, consequences and related terms to generate a greater understanding of its innate features. A systematic search relating to “therapeutic lying” and “dementia” was undertaken. The final study sample consisted of 37 papers. Results This analysis revealed therapeutic lying’s surrogate terms, attributes, antecedents, consequences and related terms in the care of a person with dementia. This study highlighted this concept is intended to be used in the person's best interests, for the purpose of doing good. However, its subjective nature makes it an extremely difficult concept to grasp collectively. Conclusion Therapeutic lying is highly dependent on individual interpretation and the caregiver’s moral compass. It can potentially damage trust in a caring relationship and may contribute to the “othering” of a person with dementia. The negative consequences surrounding this concept must be studied comprehensively before it is considered in practice. Therapeutic lying should be used only as a last resort when a person with dementia is exhibiting truth related distress. As the therapeutic effect of a therapeutic lie cannot be guaranteed, the term “well intentioned lying” is proposed as a potential alternative for the concept as this term highlights the caregiver’s good intention behind incorporating a lie during care.