title: Is there a broader role for independent mental capacity advocates in critical care? An exploratory study.
abstract: This research explores the current and potential future role of independent mental capacity advocates (IMCAs) in critical care. The Mental Capacity Act (MCA) of 2005 introduced IMCAs as advocates for patients without anyone to represent their best interests, but research suggests that this role is not well understood or implemented. No existing research explores the role of IMCAs in critical care or their potential use when families are judged 'appropriate to act' on the patient's behalf. It is suggested that families may not be best placed to advocate for their sick family member when they themselves are in a state of shock.
  
  
  
  To investigate existing levels of knowledge and awareness of the MCA and understanding of the role of IMCAs in critical care as a prelude to considering whether the role of IMCAs might usefully be extended. The concept of 'IMCA clinics' is introduced and explored.
  
  
  
  A small-scale qualitative study using thematic analysis of 15 interviews across two NHS sites and a survey of IMCA services were undertaken.
  
  
  
  Some knowledge of the MCA was evident across both study sites, but training on MCA remains unsatisfactory, with confusion about the role of IMCAs and when they should become involved. Overall, participants felt that the broader involvement of IMCAs on a regular basis within critical care could be useful.
  
  
  
  There was evidence of good practice when instructing IMCAs, but further work needs to be conducted to ensure that critical care staff are informed about the referral process. It was clear that expanding the role of an advocate warrants further investigation.
  
  
  
  Further training on the role of IMCAs within critical care is required, and good practice examples should be shared with other units to improve referral rates to the IMCA service and ensure that vulnerable patients are properly represented.
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Doris A
authors.initials: DA
authors.lastname: Chatfield
authors.affiliation: Empowerment Matters, Liscard, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Lee
authors.affiliation: Empowerment Matters, Liscard, UK.
authors.forename: Jakki
authors.initials: J
authors.lastname: Cowley
authors.affiliation: University of York, York, UK.
authors.forename: Celia
authors.initials: C
authors.lastname: Kitzinger
authors.affiliation: University of Cardiff, Cardiff, Wales.
authors.forename: Jenny
authors.initials: J
authors.lastname: Kitzinger
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: David K
authors.initials: DK
authors.lastname: Menon
mesh_terms: D001364:Awareness; D003422:Critical Care / Q000458:organization & administration*; D003657:Decision Making; D005190:Family; D006801:Humans; D016743:Mental Competency; D010344:Patient Advocacy / Q000592:standards*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Advocacy; Critical care; Mental capacity