Abstract
BackgroundThe United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. In Ireland, the Assisted Decision-Making (Capacity) Act (2015) ratifies the Convention and has established a legal framework for Assisted Decision Making (ADM). The main provisions of the Act are not yet implemented. Codes of Practice to guide health and social care professionals are currently being developed. Internationally, concerns are expressed that ADM implementation is poorly understood. Using realist synthesis, this study aims to identify Programme Theory (PT) that will inform ADM implementation in healthcare.MethodsA Rapid Realist Review using collaborative methods was chosen to appraise relevant literature and engage knowledge users from Irish health and social care. The review was led by an expert panel of relevant stakeholders that developed the research question which asks, ‘what mechanisms enable healthcare professionals to adopt ADM into practice?’To ensure the PT was inclusive of local contextual influences, five reference panels were conducted with healthcare professionals, family carers and people with dementia. PT was refined and tested iteratively through knowledge synthesis informed by forty-seven primary studies, reference panel discussions and expert panel refinement and consensus.ResultsThe review has developed an explanatory PT on ADM implementation in healthcare practice. The review identified four implementation domains as significant. These are Personalisation of Health & ADM Service Provision, Culture & Leadership, Environmental & Social Re-structuring and Education, Training & Enablement. Each domain is presented as an explanatory PT statement using realist convention that identifies context, mechanism and outcome configurations.ConclusionsThis realist review makes a unique contribution to this field. The PT can be applied by policymakers to inform intervention development and implementation strategy. It informs the imminent policy and practice developments in Ireland and has relevance for other worldwide healthcare systems dealing with similar legislative changes in line with UNCRPD.
Highlights
The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is a human rights instrument to establish a right to legal capacity for all people, including those with support needs [1]
This paper focuses on how healthcare professionals can be supported to adopt and implement Assisted Decision Making (ADM) in their practice
While ADM legislation applies to all individuals, this review focuses on ‘supported’ decision making in persons over 18 years with decision making support needs because of loss of capacity or fluctuating capacity
Summary
The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is a human rights instrument to establish a right to legal capacity for all people, including those with support needs [1]. States that have ratified the Convention are accountable to address existing barriers to this right, in legislation, policies, and practices It enables people with disabilities a fundamental right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health [2]. Individuals can name trusted supporters to assist them [5, 6]
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