Enhancing supported decision-making skills amongst health and social care staff in Ireland and the adult service-users with disabilities they support

Abstract

Introduction Decision-making capacity legislation has changed fundamentally in Ireland since 2023 with the Assisted Decision-Making (Capacity) Act 2015 (ADM). Under ADM, all adults are presumed to have capacity, unless proven otherwise. Therefore, the onus is on health and social care organisations to respond quickly, by training health and social care professionals (HSCPs) to implement the required ADM changes and prepare service-users for supported decision-making. Methods This research aimed to explore (i) HSCPs’ knowledge and understanding and barriers and facilitators, to ADM-implementation with adult service-users with intellectual disabilities; and (ii) service-user barriers and facilitators to engaging in supported decision-making. 118 HSCPs were surveyed about their knowledge, understanding and perceived barriers and facilitators to ADM-implementation. Data was analysed using content analysis and descriptive statistics. Service-users (N=16) participated in focus groups to explore their barriers and facilitators to engaging in supported decision-making. Data was analysed using Reflexive Thematic Analysis. Both studies were conducted in an Irish disability organisation. Results Survey results indicated the top three barriers to ADM-implementation were lack of family ADM-awareness, service user’s not knowing what options were available and lack of service-user knowledge of how to make decisions. The top 3 facilitators to ADM-implementation were strong leadership, effective communication skills and being skilled in helping the service-user weigh up the information about the decision. Three identified themes in the focus group data were: Intrinsic factors affecting independent decision-making; Social influences effecting decision-making and the which, who, how of supported decision-making. Conclusions Gaps exist in the ADM-knowledge and understanding of HSCPs and service-users require training to engage in supported decision-making. Results of both studies inform the design of training interventions for HSCPs and service-users.