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Developing a care pathway for advance decisions and powers of attorney: qualitative study

  • Jonathan I. Bisson (a1), Victoria Hampton (a1), Anne Rosser (a2) and Søren Holm (a3)
Abstract
Background

The Mental Capacity Act for England and Wales empowers individuals to plan ahead for when they may lack capacity.

Aims

To develop a care pathway for advance decisions and powers of attorney using Huntington's disease as an exemplar.

Method

Qualitative study using in-depth individual interviews with service users and carers, and focus groups with professionals. Inductive qualitative analysis was used to develop themes to construct a care pathway that was then piloted and further evaluated to achieve a final pathway.

Results

A care pathway was developed that incorporated an early introduction through a formal education session and a minimum of two sessions separated by at least 2 weeks before advance decision completion. Optimal delivery of this intervention requires significant clinical and administrative commitment.

Conclusions

We have developed a simple, easy-to-follow care pathway that was acceptable to users and providers.

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Copyright
Corresponding author
Jonathan I. Bisson, Department of Psychological Medicine, Cardiff University, Monmouth House, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK. Email: bissonji@cf.ac.uk
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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1 Department for Constitutional Affairs. Mental Capacity Act 2005 Code of Practice (2007 final edition). TSO (The Stationery Office), 2007.
2 Lancet. Advance directives [editorial]. Lancet 1992; 340: 1321–2.
3 Singer, P. Disease-specific advance directives. Lancet 1994; 344: 594–6.
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6 Raymont, V, Bingley, W, Buchanan, A, David, AS, Hayward, P, Wessely, S, et al. Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet 2004; 364: 1421–7.
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10 Huntington's Disease Association. Huntington's Disease and the Law. HDA, 2006 (http://www.hda.org.uk/download/acrobat/hdafs012.pdf).
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14 Martin, D, Thiel, E, Singer, P. A new model of advance care planning: observations from people with HIV. Arch Intern Med 1999; 159: 8692.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Developing a care pathway for advance decisions and powers of attorney: qualitative study

  • Jonathan I. Bisson (a1), Victoria Hampton (a1), Anne Rosser (a2) and Søren Holm (a3)
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