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Open AccessArticle

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

1
School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland
2
School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, 4 Dublin, Ireland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(9), 3294; https://doi.org/10.3390/ijerph17093294
Received: 1 April 2020 / Revised: 2 May 2020 / Accepted: 6 May 2020 / Published: 9 May 2020
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. View Full-Text
Keywords: assisted decision making; supported decision making; health system responsiveness; qualitative; person-centred care; public and patient Involvement assisted decision making; supported decision making; health system responsiveness; qualitative; person-centred care; public and patient Involvement
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MDPI and ACS Style

Ní Shé, É.; O’Donnell, D.; Donnelly, S.; Davies, C.; Fattori, F.; Kroll, T. “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. Int. J. Environ. Res. Public Health 2020, 17, 3294. https://doi.org/10.3390/ijerph17093294

AMA Style

Ní Shé É, O’Donnell D, Donnelly S, Davies C, Fattori F, Kroll T. “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. International Journal of Environmental Research and Public Health. 2020; 17(9):3294. https://doi.org/10.3390/ijerph17093294

Chicago/Turabian Style

Ní Shé, Éidín; O’Donnell, Deirdre; Donnelly, Sarah; Davies, Carmel; Fattori, Francesco; Kroll, Thilo. 2020. "“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" Int. J. Environ. Res. Public Health 17, no. 9: 3294. https://doi.org/10.3390/ijerph17093294

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