The problem

The Assisted Decision-Making Capacity Act (2015) is reshaping how we understand and provide support in Ireland to older people when they are making decisions about their healthcare. We want to know how to enable healthcare professionals to assist people in decision-making in the best possible way.

The project

The Promoting Assisted Decision-Making in Acute Care Settings (PADMACS) project led by UCD examined the research literature on what can help people with thinking and memory problems to make decisions. They also interviewed healthcare staff and older people (with and without dementia) and their carers. Based on this information, they developed a scenario-based training game.

The outcomes

The research found that:

  • A positive relationship between healthcare professionals and the older person and family carers is critical before decision points about healthcare arise
  • Older people with and without dementia and their carers are best supported in decision-making when different healthcare professionals work together
  • The hospital building and social environment can impact the capacity to make healthcare decisions.
  • The findings informed the development of a ‘serious game’. It contains evidence-informed decision-making scenarios about patients and situations in acute care, which players (healthcare professionals and students) then discuss
  • The game has been used to train healthcare professionals and students in acute and rehabilitation settings
  • The Royal College of Physicians in Ireland plans to use the game for education programmes for healthcare professionals.

Thilo Kroll, Full Professor of Health Systems Management at UCD, says:

“People have the right to be involved in making decisions about their healthcare, and we need to start out with the view that people have the capacity to do that. We must also recognise that their capacity may fluctuate over time and context. Through the PADMACS project we are providing evidence-based tools for healthcare staff, patients, and carers to work together to help protect the right of the patient to make decisions about their care whenever possible.”

The PADMACS project is a collaboration involving University College Dublin, The Royal College of Physician of Ireland, St Vincent’s University Hospital, the Mater Misericordiae University Hospital, the Alzheimer’s Society of Ireland and Family Carers Ireland.

“A serious game to support older people’s healthcare decisions” is part of a wider collection of success stories across four themes from this year’s annual Health Research in Action. Download the full publication.