Supported decision making uses a person’s support network to help them participate in decision making. This approach affirms human rights, individual autonomy, and inherent dignity, especially in the context of cognitive disability. Recent legislation changes now include supported decision making for the first time, however, understanding how to implement these changes in the acute setting is lacking. 

 

To explore clinician’s perspectives of the barriers and enablers to using supported decision making in an acute setting.

 

A qualitative study design with mixed purposive sampling was used. Twenty-six semi-structured interviews (face-to-face or videoconference) were completed with senior hospital clinicians from medical, nursing, and allied health disciplines. Transcribed interviews underwent latent coding and thematic analysis using an inductive approach.

 

Common decisions where supported decision making could be used included discharge location, medical treatment, and end-of-life care. Four main themes were identified: (1) understanding and practice; (2) hospital and legal systems; (3) collaboration, communication, and engagement; (4) time and environment. Barriers and enablers existed within each of the themes. 

 

Several barriers to the use of supported decision making in hospital were identified by clinicians, with change needed at individual and system levels in addition to legislation amendments. Training and education, resources, and development of frameworks to guide the process are essential next steps. 

 

The results provide insight into challenges clinicians face in supported decision making in an acute health setting and will guide the implementation of next steps.

 

 
Sarah Sowry1,2, Malith Ramasundara2, Patrice Higgins2
 
 

1.     University of Wollongong, Wollongong, NSW 2500

2.     Canberra Health Services, Garran, ACT, 2605