Background

Advance decision making (ADM) in mental health is supported by stakeholders but faces significant barriers. These must be overcome, not least to support the UK government's commitment to introduce statutory mental health ADM in England and Wales.

Aims

To build understanding and address the gap between aspirations for ADM and actuality, with feasible co-produced ADM resources.

Methods

We used focus groups and consultation to explore experience and views of stakeholders on ADM processes and materials. Discussions included feedback on an ADM template which was adapted accordingly throughout the research process.

Results

Between September 2017 and December 2019, 94 individuals, representing stakeholders advised on design and process of ADM, alongside wider discussion at stakeholder events. Collaborative ADM was universally supported. Valued outcomes were diverse and combining aspirations with practicality required resolving dilemmas. A prototype template and guidance, the PACT (Preferences and Advance decisions for Crisis and Treatment) was co-produced, designed to help manage fluctuating mental capacity through collaborative decision making. The PACT enables direct engagement with medico-legal frameworks, with provision to facilitate person-centred assessments, treatment refusals and requests. Resources including supported engagement and cross-agency awareness and accessibility were seen as essential.

Conclusion

Our research confirms high stakeholder motivation to engage in ADM is hampered by multiple barriers. We identified enabling conditions for ADM and co-produced an ADM template and guidance which supports achievement of a range of valued outcomes. Further developments to support and evaluate the process of implementation are now needed to prepare for statutory change.

中文翻译：

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“治疗癌症行动计划”高级决策模板：与联合制作，焦点小组和咨询一起为《精神卫生法》改革做准备。

背景

利益相关者支持精神卫生方面的预先决策（ADM），但面临着重大障碍。必须克服这些困难，尤其是要支持英国政府承诺在英格兰和威尔士引入法定精神卫生ADM的承诺。

目的

利用可行的联合生产的ADM资源，建立理解并解决ADM期望与现实之间的差距。

方法

我们使用焦点小组和咨询来探索利益相关者对ADM流程和材料的经验和看法。讨论包括对ADM模板的反馈，该模板在整个研究过程中均作了相应调整。

结果

在2017年9月至2019年12月期间，代表利益相关者的94个人就ADM的设计和流程提供了咨询，并在利益相关者活动中进行了更广泛的讨论。协作性ADM得到了普遍支持。有价值的结果是多种多样的，将愿望与实用性相结合需要解决难题。共同制作了原型模板和指南PACT（针对危机和治疗的偏好和预先决定），旨在通过协作决策来帮助管理波动的心理能力。《治疗癌症行动计划》使人们能够直接参与医疗法律框架，并提供便利以人为中心的评估，拒绝治疗和要求。包括支持的参与，跨机构意识和可及性在内的资源被认为是必不可少的。

结论

我们的研究证实，利益相关者参与ADM的积极性受到多种障碍的阻碍。我们确定了ADM的有利条件，并共同制作了ADM模板和指南，以支持实现一系列有价值的成果。现在需要进一步发展以支持和评估实施过程，以为法定变更做准备。