Brémault-Phillips Suzette, Pike Ashley, Charles Lesley, Roduta-Roberts Mary, Mitra Aruna, Friesen Steven, Moulton Lynne, Parmar Jasneet
Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 14 St., Edmonton, AB, T6G 2G4, Canada.
Division of Elderly Care, Department of Family Medicine, Glenrose Rehabilitation Hospital, 10230 111 Ave, Edmonton, AB, T5G 0B7, Canada.
BMC Res Notes. 2018 Aug 23;11(1):607. doi: 10.1186/s13104-018-3714-x.
Dementia and other chronic conditions can compromise a person's ability to make independent personal and financial decisions. In the wake of an ageing population and rising incidence of chronic conditions, the number of persons who may require Decision-Making Capacity Assessments (DMCAs) is likely to increase. Legislation (e.g., Trusteeship, Guardianship, Medical Assistance in Dying) also necessitates that DMCAs adhere to legislative requirements and principles. An intentional, explicit and systematic means of implementing standardized DMCA best-practices is advisable. This single exploratory case-study examined the perspectives of senior leaders and clinical experts regarding the utility of using the National Implementation Research Network (NIRN) Model to facilitate implementation, spread and sustainability of a DMCA Model. Participants learned about the NIRN Model and discussed its application during working and focus groups, all of which were audio-recorded, transcribed, and analyzed using thematic analysis.
Participants found that the NIRN Model aligned well with the DMCA Model, and offered utility to support implementation, spread and sustainability of DMCA best-practices. Participants also noted barriers related to its language, inability to capture personal change, resource requirements, and complexity. It was recommended that a NIRN-informed DMCA-specific implementation framework and toolkit be developed and NIRN-champions be available to guide implementation.
痴呆症和其他慢性病会损害一个人做出独立的个人和财务决策的能力。随着人口老龄化和慢性病发病率的上升，可能需要进行决策能力评估（DMCA）的人数可能会增加。立法（如托管、监护、医疗协助死亡）也要求DMCA必须遵守立法要求和原则。采用一种有意、明确且系统的方式来实施标准化的DMCA最佳实践是明智的。这个单一的探索性案例研究考察了高级领导人和临床专家对于使用国家实施研究网络（NIRN）模型来促进DMCA模型的实施、推广和可持续性的效用的看法。参与者了解了NIRN模型，并在工作小组和焦点小组中讨论了其应用，所有这些都进行了录音、转录，并使用主题分析法进行了分析。
参与者发现NIRN模型与DMCA模型非常契合，并为支持DMCA最佳实践的实施、推广和可持续性提供了效用。参与者还指出了与其语言、无法捕捉个人变化、资源需求和复杂性相关的障碍。建议制定一个基于NIRN的特定于DMCA的实施框架和工具包，并配备NIRN倡导者来指导实施。
