Advanced care planning: an exploratory study of community-based mental health practitioners’ views and experiences of ACP in practice with people with dementia
Authors: Manthorpe Jill , Goodwin Kevin 
Published: October 2019

Purpose
Advanced care planning (ACP) involves the discussion of preferences relevant to a possible future time when one’s ability to make decisions may be compromised. ACP is considered as having potential to enhance choice and control and thereby to improve the experience of care for people with dementia and their carers. Care coordinators have been highlighted as possibly playing a central role in facilitating these discussions among people with long-term care needs. However, there is limited evidence of how ACP is facilitated by community mental health professionals who may be supporting people with dementia and carers. The paper aims to discuss this issue.

Design/methodology/approach
This exploratory study took the form of qualitative semi-structured interviews to explore the views and experiences of community mental health professionals when discussing ACP with people with dementia and/or their carers. A convenience sample of 14 participants working in community mental health services in one NHS Mental Health Trust in London, England, was recruited and interview data were analysed using a framework approach.

Findings
Five themes emerged from the interviews – knowledge and experience, use of ACP, inhibitors of discussion, service influences and the future. The depth of ACP facilitation appeared dependent on the knowledge, confidence and skills of the individual professional. Limited resources leading to service rationing were cited as a major barrier to ACP engagement. Helping people with dementia and their carers with ACP was not viewed as a priority in the face of competing and increasing demands. A further organisational barrier was whether ACP was viewed by service managers as “core business”. Findings indicate that practice was generally to refer people with dementia to other agencies for ACP discussions. However, pockets of ACP practice were reported, such as explaining proxy decision making options for finances.

Research limitations/implications
This exploratory study took place in the community mental health services in one NHS Mental Health Trust that may not be representative of other such teams. Case records were not scrutinised or clinical conversations with people with dementia or carers.

Practical implications
Barriers to initiating ACP discussions were cited, such as limited resources, lack of time and knowledge; unclear role remit, uncertain service direction and poor documentation sharing processes. However, participants held a common belief that ACP for people with dementia is potentially important and were interested in training, a greater team focus on ACP and pathway development. This indicates the potential for staff development and continuing professional development.

Originality/value
Few studies have asked a wide range of members of community mental health services about their knowledge, skills and confidence in ACP and this study suggests the value of taking a team-wide approach rather than uni-professional initiatives.