“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

Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 inIreland and will be commenced in 2021. This paper is focused on this pre-implementation stage withinthe acute setting and uses a health systems responsiveness framework. Methods: We conductedface-to-face interviews using a critical incident technique. We interviewed older people includingthose 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 healthcaresystem that is currently under significant pressures. HSCPs are doing their best, but they are oftenhalted from delivering on the will and preference of their patients. Many older people and familycarers feel that they must be very assertive to have their preferences considered. All expressedconcern about the strain on the healthcare system. There are significant environmental barriers thatare hindering ADM practice. Conclusions: The commencement of ADM provides an opportunityto redefine the provision, practices, and priorities of healthcare in Ireland to enable improvedpatient-centred care. To facilitate implementation of ADM, it is therefore critical to identify andprovide adequate resources and work towards solutions to ensure a seamless commencement ofthe legislation.>