Advance Care Planning and the Mental Capacity Act in Specialist Neurological and Palliative Care Centres

Project Duration

May 2005 - December 2009

Funder

Sue Ryder Care and the Social Care Institute for Excellence

Aims

This was a two part study looking at the implementation and use of advance care planning in relation to the mental capacity act in specialist neurological and palliative care centres.

Methods

Part one used an audit tool to evaluated the use of the mental capacity act documentation implemented throughout Sue Ryder Care. The audit took place between May-June 2008 in six Sue Ryder Care centres: three hospices and three neurological care centres. 60 sets of notes (40%) were audited (10 per site). Record keeping systems differed at each site, and sometimes in different units within a site. Different types of supporting documents were also used making consistency an issue. A number of issues were found in the formatting of the forms used to document end of life care decisions and preferences and these were fed back to the service providers. 

The second part of the study was to gain staff views of the documentation and their understanding of its use. Interviews were conducted with staff from the six sites involved in part one. These interviews took place between January-April 2009 with 26 members of staff from a range of professions including medical staff and nursing staff. The interviews gave greater insight into the utility and appropriateness of the current documentation. Although the new documentation aided the process of record keeping the majority of staff felt that its impact on practice delivery was minimal as the majority of issues were already being addressed in various ways. However staff had some gaps in their knowledge, particularly in relation to care planning documents and this influenced their confidence to discuss these issues with service users and families. Some difference between the centres was evident. The nurse led neurological centres were more confident in their assessments of capacity as they generally work without medical support. At the palliative care centres where services users may be less familiar to staff, greater reliance may need to be placed on relatives when making 'best interest' decisions.

Outcomes and Findings

Project is now complete. For outcome please see publications.