Abstract
BackgroundIn Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity. Although these representatives only rarely are qualified in healthcare, they nevertheless play decisive roles in the decision-making processes for people with dementia. Previously, we developed an education program (PRODECIDE) to address this shortcoming and tested it for feasibility. Typical, autonomy-restricting decisions in the care of people with dementia—namely, using percutaneous endoscopic gastrostomy (PEG) or physical restrains (PR), or the prescription of antipsychotic drugs (AP)—were the subject areas trained. The training course aims to enhance the competency of legal representatives in informed decision-making. In this study, we will evaluate the efficacy of the PRODECIDE education program.MethodsA randomized controlled trial with a six-month follow-up will be conducted to compare the PRODECIDE education program with standard care, enrolling legal representatives (N = 216). The education program lasts 10 h and comprises four modules: A, decision-making processes and methods; and B, C and D, evidence-based knowledge about PEG, PR and AP, respectively.The primary outcome measure is knowledge, which is operationalized as the understanding of decision-making processes in healthcare affairs and in setting realistic expectations about benefits and harms of PEG, PR and AP in people with dementia. Secondary outcomes are sufficient and sustainable knowledge and percentage of persons concerned affected by PEG, FEM or AP. A qualitative process evaluation will be performed. Additionally, to support implementation, a concept for translating the educational contents into e-learning modules will be developed.DiscussionThe study results will show whether the efficacy of the education program could justify its implementation into the regular training curricula for legal representatives. Additionally, it will determine whether an e-learning course provides a valuable backup or even alternative learning strategy.Trial registrationTRN: ISRCTN17960111, Date: 01/06/2017.
Highlights
In Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity
We developed an education program for legal representatives and tested its feasibility in a pilot study at the University Hamburg, which ran from April 2013 until September 2015 [34]
The key hypothesis is that legal representatives allocated to the education group would achieve a better understanding of decision-making processes and higher levels of realistic expectations regarding probabilities of benefits and harms of percutaneous endoscopic gastrostomy (PEG), physical restrains (PR) and antipsychotic drugs (AP) to people with dementia compared to the control group
Summary
In Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity. These representatives only rarely are qualified in healthcare, they play decisive roles in the decision-making processes for people with dementia. We developed an education program (PRODECIDE) to address this shortcoming and tested it for feasibility. The legal representatives only rarely have a qualification in the field of healthcare [5], they are required to take a major role in decision-making processes for people with dementia [3]. Core competencies to support healthcare decision-making cannot be presupposed
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
