171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are:</jats:p> <jats:p>AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.</jats:p> </jats:sec>