Developing a care pathway for advance decisions and powers of attorney: qualitative study

BACKGROUND: The Mental Capacity Act for England and Wales empowers individuals to plan ahead for when they may lack capacity. AIMS: To develop a care pathway for advance decisions and powers of attorney using Huntington's disease as an exemplar. METHOD: Qualitative study using in-depth individual interviews with service users and carers, and focus groups with professionals. Inductive qualitative analysis was used to develop themes to construct a care pathway that was then piloted and further evaluated to achieve a final pathway. RESULTS: A care pathway was developed that incorporated an early introduction through a formal education session and a minimum of two sessions separated by at least 2 weeks before advance decision completion. Optimal delivery of this intervention requires significant clinical and administrative commitment. CONCLUSIONS: We have developed a simple, easy-to-follow care pathway that was acceptable to users and providers.