“ 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, Deirdre O’Donnell, Sarah Donnelly, Carmel Davies, Francesco Fattori and Thilo Kroll
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Éidín Ní Shé: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland
Deirdre O’Donnell: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland
Sarah Donnelly: School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, 4 Dublin, Ireland
Carmel Davies: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland
Francesco Fattori: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland
Thilo Kroll: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland

IJERPH, 2020, vol. 17, issue 9, 1-13

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.

Keywords: assisted decision making; supported decision making; health system responsiveness; qualitative; person-centred care; public and patient Involvement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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