Supported decision making – perceived barriers and enablers within an acute hospital
Patrice Higgins1, Sarah Sowry2, Malith Ramasundara1 1Canberra Health Services, Canberra, ACT, Australia2University of Wollongong, Wollongong, NSW, Australia
Abstract
Background of the Project
Supported decision-making (SDM) is a person-centred and human rights approach which utilises supportive relationships to assist people in making their own decisions based on their will and preferences. Implementing SDM and promoting dignity of risk in the acute hospital setting is challenging.
We aimed to explore clinicians’ perspectives regarding the use of SDM among hospitalised patients with cognitive impairment and identify barriers and enablers for implementation.
Method
A qualitative approach with mixed purposive sampling was employed. Twenty-six senior hospital clinicians were invited to participate in semi-structured face-to-face or videoconference interviews and focus groups. Clinicians were recruited from occupational therapy, physiotherapy, social work, speech pathology, neuropsychology and consultant physicians and clinical nurses. Data from transcribed audio recordings were evaluated using thematic analysis.
Results
Perceived barriers limiting SDM:
•A lack of resources, including clinician time and availability of quiet spaces for discussion.
•Variable conceptual and practical understanding of SDM and inconsistent approaches by clinicians in assessment of capacity and respect for dignity in risk taking.
•Existing systems promote substitute decision making due to an absence of legal framework for SDM and an organisational drive to discharge patients efficiently.
Key enablers supporting SDM:
•Meaningful engagement with patients, supported communication strategies, and inter-professional collaboration amongst the multidisciplinary team.
Discussion
Overall, there was a willingness and desire to use SDM among clinicians, however, several perceived barriers exist at individual and systems levels. A multi-pronged approach to change is needed, including standardised education, guiding frameworks and resources for staff.
Biography
Biographies to come