Protocol for a scoping review to understand what is known about how GPs make decisions with, for and on behalf of patients who lack capacity

Jack Ogden*, Richard Huxtable, Jonathan C S Ives

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Introduction
GPs and allied health care professionals working in primary care are regularly required to make decisions with, for and on behalf of patients who lack capacity. In England and Wales these decisions are made for incapacitated adult patients under the Mental Capacity Act 2005 (MCA), which primarily requires that decisions are made in the patient’s “best interests”. Regarding children, decisions are also made in their best interests but are done so under the Children Act 1989, which places paramount importance on the welfare of the child. Decisions for children are usually made by parents, but a GP may become involved if he or she feels a parent is not acting in the best interests of the child. Internationally, including elsewhere in the UK, different approaches are taken. We hypothesise that, despite the legislation and professional guidelines, there are many different approaches taken by GPs and allied healthcare professionals in England and Wales when making these complex decisions with, for and on behalf of patients who lack capacity. To better understand what is known about how these decisions are made, we plan to undertake a scoping review and directed content analysis of the literature. While the majority of decisions made in primary care are made by GPs, for completeness, this review will include all allied health care professionals working in
primary care.

Methods and analysis
To ensure a wide breadth of literature is captured, a scoping review will be undertaken as described by Arksey and O’Malley (2005). A five-stage approach will be taken when conducting this review:
(1) Identifying the research question;
(2) Identifying relevant papers;
(3) Study selection;
(4) Data extraction; and
(5) Summarising and Synthesis.
The final stage will include a directed content analysis of the data to help establish the cross-cutting themes.

Ethics and dissemination
The scoping review will be disseminated through conferences and peer-reviewed publications. This scoping review is the first (mapping) phase in a proposed larger study to explore how GPs make decisions with, for and on behalf of those who lack capacity. Qualitative research with GPs, patients
and their families will follow, before all the results are synthesised using an “empirical bioethics” methodology.

STRENGTHS AND LIMITATIONS OF THIS STUDY
• This scoping review will map the current understanding of how decisions are or should be made in primary care with, for and on behalf of patients who lack capacity
• Arksey and O'Malley's scoping review methodology will be used and it will follow the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist.
• An international search will allow comparison of approaches between different legal jurisdictions.
• The data will be critically synthesised with reference to ethical and legal principles to identify cross-cutting themes and to ascertain where further research is needed on this increasingly important topic.
Original languageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 13 Sep 2020

Keywords

  • Best interests
  • Incapacity
  • Decision-making
  • Empirical bioethics

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