Promoting assisted decision-making in acute care settings for care planning purposes: Study protocol

O’Donnell, Deirdre; Shé, Éidín Ní; Davies, Carmel; Donnelly, Sarah; Cooney, Therese; O'Coimin, Diarmuid; O’Shea, Diarmuid; Kyne, Lorraine; O'Sullivan, Diarmaid; Rock, Bernadette; O’Shea, Marie; McAuliffe, Éilish; O'Shaughnessy, Ann; Kroll, Thilo

doi:10.12688/hrbopenres.12797.1

Cited by 13 publications

(20 citation statements)

References 27 publications

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“…The expert panel reconvened in July 2018 and reviewed the extracted data. The expert panel via consensuses validated and prioritized 33 programme theories linking them to the adopted contextual policy categories as noted in the BCW . The programme theories were generated from the review and synthesis of findings from the literature, refinement in discussions with reference panels and via the final consensus meeting with the expert panel (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…The linking to the BCW policy categories was used in the template to examine the developed programme theories by providing a contextual overview. The BCW is a recent but increasingly popular taxonomy to assist the development and implementation of behaviour change interventions . In this review, the BCW was used to describe the mechanisms and related resources of involving seldom heard groups in relation to specific contextual factors.…”

Section: Methodsmentioning

confidence: 99%

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Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

Shé

Morton

Lambert

et al. 2019

Health Expectations

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Objective Public and patient involvement is increasingly embedded as a core activity in research funding calls and best practice guidelines. However, there is recognition of the challenges that prevail to achieve genuine and equitable forms of engagement. Our objective was to identify the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research. Methods A rapid realist review of the literature that included: (a) a systematic search of CINAHL, PsycINFO, PubMed and Open Grey (2007‐2017); (b) documents provided by expert panel members of relevant journals and grey literature. Six reference panels were undertaken with homeless, women's, transgender, disability and Traveller and Roma organizations to capture local insights. Data were extracted into a theory‐based grid linking context to behaviour change policy categories. Main results From the review, 20 documents were identified and combined with the reference panel summaries. The expert panel reached consensus about 33 programme theories. These relate to environmental and social planning (7); service provision (6); guidelines (4); fiscal measures (6); communication and marketing (4); and regulation and legislation (6). Conclusions While there is growing evidence of the merits of undertaking PPI, this rarely extends to the meaningful involvement of seldom heard groups. The 33 programme theories agreed by the expert panel point to a variety of mechanisms and resources that need to be considered. Many of the programme theories identified point to the need for a radical shift in current practice to enable the reciprocal involvement of seldom heard groups.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

Shé

Morton

Lambert

et al. 2019

Health Expectations

Self Cite

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“…The Act promotes the autonomy of the person in relation to their treatment choices and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision‐making into the care of adults that mirrors the uncertainty voiced in the international literature (Irish Hospice Foundation, 2016; O'Donnell et al., 2018). This paper aimed to review the global literature on advance health care directives to date, and the experiences of the health care professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, it ratifies the UN Convention of Rights of Persons with Disabilities (2006), the European Convention of Human Rights (2003) and the Hague Convention on the International Protection of Adults (2000). Existing legislation satisfied a number of Articles in the UN, Hague and European Conventions; however, notable gaps were identified in the areas of consent and deprivation of liberty, which are now being addressed, making it legislation to be celebrated (O'Donnell et al., 2018), and which represents ‘ a seismic cultural shift towards a rights‐based approach of choice, control and consent ’ (Inclusion Ireland, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…The Irish Hospice Foundation (2016) cites that the process of compiling an advance health directive is fraught with ethical issues. Equally, lack of consensus over Irish guidance documents for health care professionals means that take‐up rates remain low (Carr & Luth, 2017), and health care professionals remain unsure of how to implement them (O'Donnell et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

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Implementing advance directives—An international literature review of important considerations for nurses

2020

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Aim(s) To review the global literature on the implementation of advance health care directives to date, and the experiences of the health care professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions. Background Ireland's Assisted Decision‐Making (Capacity) Act 2015 legalizes advance health care directives. It promotes the autonomy of the person and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision‐making. Evaluation 16 studies featuring the views of health care professionals are included and evaluated using a framework of ‘benefits versus challenges’. Key issue(s) Four themes clearly emerge during the review process: the concept of capacity and who decides; autonomy versus paternalism—conflict among the health care professional/patient/family caregiver triad; barriers to advance directives; and timing issues. Conclusion(s) Significant benefits of advance health care directives exist for all parties including less stress for patients and families alike, less burden and less residual guilt for surviving relatives, and an over‐arching prevention of ‘crisis’ decision‐making. Implications for Nursing Management This review highlights the central role of the nurse in empowering patients to express their wills and preferences, supporting patients' capacity to make decisions about their own care, initiating end‐of‐life care discussions and advocating to have advance health care directives acknowledged. Moreover, it identifies the challenges ahead for all nurse managers in implementing this new mandate.

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How comprehensive is our comprehensive geriatric assessment in clinical practice? An Irish perspective

Dennehy,

Lynch,

Reddin

et al. 2024

Eur Geriatr Med

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Purpose Comprehensive geriatric assessment (CGA) is the cornerstone of high-quality care for older adults. There is no current gold standard to guide what should be included as the baseline measure for CGAs. We examined what metrics are being captured in CGA baseline assessments completed by community based integrated care teams in Ireland. Methods CGA’s care pathways in Ireland are usually initiated with a written document that establish patients baseline in various assessment areas. These documents were the focus of this study. We completed a cross-sectional study of the components captured in CGA baseline assessments completed in a community setting. We contacted operational leads in each of the community health organisations in Ireland and requested a copy of their current initial baseline screening document for CGA. Results We reviewed 16 individual CGA baseline documents for analysis in this study. Common assessment areas in all documents included frailty (with the Rockwood Clinical frailty scale used in 94%, n = 15), cognition (4AT—56% of CGAs, MMSE—25%, MOCA—25%, AMTS—19%, AD8—19%, Addenbrookes—13%, 6CIT—13%, mini cog—6%), mobility (100%, n = 16), falls (100%, n = 16), continence (100% n = 16), nutrition (100% n = 16). Mood (94%, n = 15), pain (44%, n = 7), bone health (63%, n = 10), sleep (62%, n = 10) and skin integrity (56%, n = 9). Formal functional assessment was completed in 94% (n = 15) of CGAs with the Barthel index being the tool most used 81% (n = 13). Half of the CGAs included a section describing carer strain (50%, n = 8). The majority of CGAs included a patient centred question which was some variation of ‘what matters most to me’ (75% n = 11). 87.5% of assessments included a care plan summary (n = 14). Conclusions This report highlights that the core tenets of CGA are being assessed across different community based initial CGA screening instruments. There was significant variability in the discussion of challenging topics such as carer strain and social well-being. Our results should prompt a discussion about whether a minimum dataset should be developed for inclusion in nationwide initial baseline CGA document, aiming to improve standardisation of assessments, which will impact areas highlighted for intervention and ultimately guide population health policy.

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Promoting assisted decision-making in acute care settings for care planning purposes: Study protocol

Cited by 13 publications

References 27 publications

Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

Implementing advance directives—An international literature review of important considerations for nurses

How comprehensive is our comprehensive geriatric assessment in clinical practice? An Irish perspective

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