Abstract
ObjectiveDementia and other chronic conditions can compromise a person’s ability to make independent personal and financial decisions. In the wake of an ageing population and rising incidence of chronic conditions, the number of persons who may require Decision-Making Capacity Assessments (DMCAs) is likely to increase. Legislation (e.g., Trusteeship, Guardianship, Medical Assistance in Dying) also necessitates that DMCAs adhere to legislative requirements and principles. An intentional, explicit and systematic means of implementing standardized DMCA best-practices is advisable. This single exploratory case-study examined the perspectives of senior leaders and clinical experts regarding the utility of using the National Implementation Research Network (NIRN) Model to facilitate implementation, spread and sustainability of a DMCA Model. Participants learned about the NIRN Model and discussed its application during working and focus groups, all of which were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsParticipants found that the NIRN Model aligned well with the DMCA Model, and offered utility to support implementation, spread and sustainability of DMCA best-practices. Participants also noted barriers related to its language, inability to capture personal change, resource requirements, and complexity. It was recommended that a NIRN-informed DMCA-specific implementation framework and toolkit be developed and NIRN-champions be available to guide implementation.
Highlights
Adults are presumed to be independent decision-makers regarding their personal and financial affairs
Participants found that the National Implementation Research Network (NIRN) Model aligned well with the Decision-Making Capacity Assessment (DMCA) Model, and offered utility to support implementation, spread and sustainability of DMCA best-practices
It was recommended that a NIRN-informed DMCA-specific implementation framework and toolkit be developed and NIRN-champions be avail‐ able to guide implementation
Summary
Adults are presumed to be independent decision-makers regarding their personal (e.g., health, housing, associations, legal) and financial affairs. In the wake of an ageing population, increasing incidence of chronic conditions and legislative requirements (e.g., Guardianship and Trusteeship, Medical Assistance in Dying), DMCA best-practices and processes need to be standardized and better-integrated into routine care. Adherence to such processes best-positions healthcare professionals to determine person-centred outcomes that are least restrictive and intrusive, and that maximize autonomy. The DMCA Model aims to enable independent practitioners, IP teams, organizations, and large-scale systems to effectively conduct DMCAs. The Model outlines a standardized process aligned with provincial legislation. Its aim is to support screening and pre-assessment, facilitate problem-solving, support documentation, facilitate education and mentoring, and enable widespread implementation, spread and sustainability of DMCA best-practices
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