Assisted decision-making and interprofessional collaboration in the care of older people: a qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting

Ambulance clinicians’ attitudes to older patients’ self‐determination when the patient has impaired decision‐making ability: A Delphi study

“…For example, ethical conflicts arose when healthcare professionals tried to support the will and preference of older patients, while other professionals colluded with family members and made decisions for the patient's 'best interests'. Conversely, there was interdependence between older patients and their family members, and those patients with cognitive impairments needed their family to be involved in decision-making (Donnelly et al, 2021). However, despite common goals between the older patient and relatives, these goals tend to differ when the patient's condition becomes unstable, their functional or cognitive health fails, or when there is a threat to patient safety (Kuluski et al, 2013).…”

Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

“…5,19 This requires a cultural change that will challenge hierarchical leadership within MDTs through the inclusion and empowerment of relevant specialist skills and disciplinary knowledge. 7 This case report illustrates a collaborative multidisciplinary approach, with the utilisation of expert skills of relevant disciplines. This approach provided the necessary scaffolding to reveal the functional capacity of this patient.…”

“…In Ireland, as in other jurisdictions, legislative and policy innovations in response to the ratification of UNCRPD have proved challenging for implementation in health and social care settings. [4][5][6][7] The ADM Act places an onus on Health and Social Care Professionals (HSCPs) to use supports that would scaffold the functional capacity of an individual to assist their healthcare decision-making. Overcoming communication barriers to accurately determine capacity and identify the appropriate supports for decision-making is a significant challenge for HSCPs.…”

Assessing Older Adults’ Decision-Making Capacity for Independent Living: Practice Tensions and Complexities

“…However, recent legislation and literature has emphasised the role of all HCPs in determining a person’s DMC, and Irish legislation states that the DMC assessment be carried out by the HCP with expertise specific to the area of DMC under question. Recent national and international literature refers to nurses, occupational therapists, physicians, physiotherapists, psychiatrists, psychologists, social workers and speech and language therapists being involved in DMC assessments, which typically occur in hospital settings (Donnelly et al, 2021; Jayes et al, 2020). However, Irish research indicates that traditional hierarchical cultures embedded within healthcare organisations may foster an approach where some HCPs’ skills and insights on DMC are overlooked (Ní She et al, 2020).…”

“…Engagement of HCPs in the assessment of DMC may also be hampered by the lack of guidance documents and procedures for HCPs to apply the legislative requirements of DMC assessment in practice. Research highlights that many HCPs find DMC assessment challenging, noting inadequate knowledge of the concepts of DMC or how to undertake DMC assessment, competing demands within pressurised healthcare settings and lack of MDT collaboration as factors that impede HCPs engagement in DMC assessment (Davies et al, 2019; Donnelly et al, 2021; Ganzini et al, 2003; Jayes et al, 2020; Lamont et al, 2017; Usher & Stapleton, 2020; Young et al, 2018).…”