Stephenson Lucy A, Gergel Tania, Ruck Keene Alex, Rifkin Larry, Owen Gareth
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK.
39 Essex Chambers, 81 Chancery Lane, London, WC2A 1DD, UK.
Wellcome Open Res. 2022 Jul 7;7:182. doi: 10.12688/wellcomeopenres.17947.1. eCollection 2022.
Background Advance Decision Making (ADM) is strongly supported by stakeholders but implementation remains challenging. In England and Wales, implementation strategies are urgently required to prepare for the introduction of mental health 'Advance Choice Documents' (ACDs) as part of Mental Health Act reforms. We report on a pilot project which aimed to co-produce and evaluate implementation strategies for ACDs with those who experience fluctuating mental capacity in the context of bipolar. Methods A co-produced prototype ACD template was piloted in 'Plan, Do, Study Act' (PDSA) cycles. Implementation strategies were co-produced with participants and mapped onto the Expert Recommendations for Implementing Change (ERIC) framework. Strategies were evaluated during thematically analysed qualitative interviews. Results We piloted the template with 17 service users during 5 successive PDSA cycles and conducted 75 in depth interviews with stakeholders. Key strategies identified as accessible, appropriate and feasible were: interactive assistance from an independent 'supporter', a structured template and active offers of involvement to service users and informal carers. Conclusions Mental health professionals and organisations must prepare for increased expectations around mental health ADM. We recommend further pilot projects and the establishment of 'ACD workshops'. Resource is essential to fund independent 'supporters', training, network building and embedding ADM in clinical pathways.
背景 预先决策（ADM）得到了利益相关者的大力支持，但实施起来仍具有挑战性。在英格兰和威尔士，迫切需要实施策略，为引入作为《精神健康法》改革一部分的精神健康“预先选择文件”（ACD）做好准备。我们报告了一个试点项目，该项目旨在与双相情感障碍背景下精神能力波动的患者共同制定和评估ACD的实施策略。方法 一个共同制作的ACD原型模板在“计划、执行、研究、行动”（PDSA）循环中进行了试点。实施策略与参与者共同制定，并映射到《实施变革专家建议》（ERIC）框架上。在进行主题分析的定性访谈期间对策略进行了评估。结果 我们在连续5个PDSA循环中与17名服务使用者对该模板进行了试点，并与利益相关者进行了75次深度访谈。确定为可获取、适当且可行的关键策略包括：来自独立“支持者”的互动协助、结构化模板以及向服务使用者和非正式护理人员主动提供参与机会。结论 精神健康专业人员和组织必须为围绕精神健康ADM不断增加的期望做好准备。我们建议开展进一步的试点项目并设立“ACD工作坊”。资源对于资助独立“支持者”、培训、建立网络以及将ADM纳入临床路径至关重要。
