"What Bothers Me Most Is the Disparity between the Choices that People Have or Don't Have": A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland.

Éidín Ní Shé,Carmel Davies,Thilo Kroll,Sarah Donnelly,Deirdre O’Donnell,Francesco Fattori

doi:10.3390/ijerph17093294

Abstract

Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.

Highlights

There is a formal recognition within health and social care systems that patients should be assisted in the decisions about their care [1,2,3]
The themes generated from the interview data were coded using the health system responsiveness conceptual framework (Figure 1) [15] involved the following three main domains: 1
The use of the health system responsiveness framework provides a useful oversight to capture the performance of the Irish health system as the new Assisted Decision-Making (ADM) legislation is about to be commenced [15,27,28]

Summary

Introduction

There is a formal recognition within health and social care systems that patients should be assisted in the decisions about their care [1,2,3] Following this shift in 2015, the Assisted Decision-Making (ADM) (Capacity) Act was enacted in Ireland [4,5,6]. Conventions: the UN Convention of the Rights of Persons with Disabilities (2006) and the Hague Convention on the International Protection of Adults (2000) [3,5,6] It is a significant piece of legislation providing the reform of the law regarding adults (18+) who require, or who may require, assistance in exercising their decision-making capacity [6].

Results

Discussion

Conclusion