Beyond truth and deception: a contextual decision-making model for dementia care

Purpose This study aims to develop the Contextual Decision-Making Model in Dementia Care (CDM-DC), a practice-oriented framework for structuring professional deliberation when factual truthfulness, experienced reality and emotional well-being come into tension. Design/methodology/approach The CDM-DC was developed through an integrative process of conceptual analysis and synthesis drawing on literature on therapeutic lying and deception, dementia communication, person-centred care, professional judgement and ethical decision-making. Findings The model comprises three interrelated levels: situational assessment, consideration of a repertoire of communicative strategies and ethical-contextual validation. It distinguishes six communicative strategies ranging from adapted truth-telling to therapeutic lying and proposes five criteria for evaluating the appropriateness of a proposed response. The model is iterative rather than prescriptive, allowing decisions to be reconsidered as circumstances or consequences change. Practical implications The CDM-DC provides a common structure and vocabulary for examining complex communicative situations in dementia care and may support professional reflection, supervision, education and interdisciplinary ethical deliberation. As a conceptual framework, its practical utility requires subsequent empirical examination. Originality/value The model moves beyond the conventional truth-versus-lying dichotomy by integrating contextual assessment, communicative alternatives and explicit ethical scrutiny within a single decision-making framework.