The British Journal of Psychiatry (2009) 194: 55-61. doi: 10.1192/bjp.bp.107.048900
© 2009 The Royal College of Psychiatrists
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Developing a care pathway for advance decisions and powers of attorney: qualitative study

Jonathan I. Bisson, DM, FRCPsych and Victoria Hampton, BSc

Department of Psychological Medicine, Cardiff University, University Hospital of Wales

Anne Rosser, PhD, FRCP

Departments of Neurology and Medical Genetics, Cardiff University, University Hospital of Wales

Søren Holm, MD, PhD

Cardiff Law School, Cardiff University, Museum Avenue, Cardiff, UK

Correspondence: Jonathan I. Bisson, Department of Psychological Medicine, Cardiff University, Monmouth House, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK. Email: bissonji{at}cf.ac.uk

Declaration of interest

None. Funding detailed in Acknowledgements.

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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