Decision-making capacity and aphasia: speech-language pathologists’ perspectives

Suleman, Salima; Hopper, Tammy

doi:10.1080/02687038.2015.1065468

Cited by 19 publications

(27 citation statements)

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“…When a person's ability to make decisions may be affected by neurological pathologies, a capacity assessment is carried out to determine his/her ability to make a particular decision. Because capacity assessment relies heavily on language skills, demonstrating capacity is often challenging or may be impossible for people with aphasia (PWA) (Carling-Rowl & Wahl, 2010;Pachet, Allan, & Erskine, 2012;Suleman & Hopper, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Research has shown that PWA may not be able to demonstrate their true decision-making abilities due to their language difficulties (Carling-Rowl & Wahl, 2010;Pachet et al, 2012;Suleman & Hopper, 2016). Aphasia can occur along with significant impairments in memory, attention, executive functioning, which further complicates the decision-making processes (Murray, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Aphasia can occur along with significant impairments in memory, attention, executive functioning, which further complicates the decision-making processes (Murray, 2012). The literature on capacity assessment in PWA highlights the need for involving speech and language therapists (SLTs) on a regular basis for capacity assessments (e.g., Suleman & Hopper, 2016). SLTs are trained to assess communication impairments in aphasia, to identify the remaining verbal and non-verbal abilities, and to identify methods of supporting communication to compensate or learn new ways of communicating.…”

Section: Introductionmentioning

confidence: 99%

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Decision-making capacity in aphasia: SLT’s contribution in England

2017

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Background: Individuals' right to be involved with decisions regarding their health and social care is the cornerstone for modern patientcentred care. Decision-making is a complex process that involves multiple cognitive and linguistic abilities. These are often challenging for people with aphasia (PWA). The Mental Capacity Act (MCA) Code of Practice (2007) recommends that speech and language therapists (SLTs) support capacity assessments for individuals with communication problems, such as PWA. To date, little is known regarding SLTs' involvement in the UK for supporting decision-making and capacity assessment for PWA. Aims: This research provides data to document when, how, and the extent to which SLTs are being used in capacity assessment for PWA in England. We also determined SLTs' training and resource needs in capacity assessments, and their role in inter-professional training. Methods & Procedures: 56 SLTs working with PWA from a wide range of clinical settings in England were recruited; they completed a secure questionnaire using the online survey tool Survey Monkey. The questionnaire collected information in the following areas: knowledge and awareness of the MCA; current involvement of SLTs in capacity assessments and decision-making; inter-professional understanding of SLTs roles in capacity assessments; and training needs of SLTs. Outcomes & Results: The SLTs who participated in this survey indicated that they were not regularly involved to support capacity assessment for PWA. Moreover, they also reported that other professionals on the care team did not fully recognise or utilise their skills in supporting capacity assessment for PWA. Moreover, SLTs were not solicited to train professionals regarding communication difficulties in aphasia and its impact on capacity assessments. SLTs wanted profession-specific training to fulfil the role of supporting PWA in capacity assessments more effectively and reliably. Conclusions: Healthcare professionals have an ethical duty to ensure that judgements of capacity are unbiased and accurate. SLTs have an important contribution to make but their skills and knowledge are not fully recognised or utilised. These findings highlight an important need to raise the profile of SLTs' skills and expertise amongst professionals through education and/or inter-professional communications. This would enable SLTs to be regularly and effectively utilised in capacity assessments and decision-making for PWA. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decision-making capacity in aphasia: SLT’s contribution in England

2017

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“…Communication can be supported through a variety of means, including: using simplified language; speaking at a slower rate; pausing more frequently; using hearing aids; writing key words; repeating important points; using both open-and close-ended questions; ensuring direct face-to-face conversation; and involving communication specialists such as SLPs (Brady & Kirschner, 1995;Carling-Rowland & Wahl, 2010;Ferguson, Duffield, & Worrall, 2010;Giampieri, 2012;Kagan, 1998;Pachet et al, 2012;Stein & Brady Wagner, 2006). Indeed, SLPs have emphasised their specialised training and their role as "interpreters" for people with aphasia during capacity assessments when asked about their current and/or potential role in the capacity assessment process (ACSLPA, 2012;Ferguson et al, 2010;Suleman & Hopper, 2013). In the literature on capacity assessment in aphasia, it is generally assumed that although communication facilitation may be necessary, the decision-making abilities of the person with aphasia are intact.…”

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confidence: 98%

“…Capacity assessments typically consist of clinical interviews, and therefore can be highly linguistic in nature. Speech-language pathologists (SLPs) and other professionals have expressed concerns that people with communication disorders such as aphasia may not be able to demonstrate their true decision-making abilities (Carling-Rowland & Wahl, 2010;Pachet, Allan, & Erskine, 2012;Suleman & Hopper, 2013). As such, there is a growing body of literature advocating for capacity assessment teams to support the communication process.…”

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confidence: 98%

Decision-making, cognition, and aphasia: developing a foundation for future discussions and inquiry

Suleman

Kim

2015

Aphasiology

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Background: Making a decision is a cognitive task that requires the use of cognitive functions such as attention, memory, language, and executive function. Researchers have found people with cognitive deficits perform worse than healthy controls on experimental measures of decision-making. Researchers have also shown that persons with aphasia (PWA) may have deficits in the cognitive functions implicated in rational decision-making. Aims: In this paper, we will discuss the cognitive processes associated with decision-making by examining decision-making abilities in populations with cognitive deficits. Then we will discuss cognitive functions within the dual-process theory of decision-making, and describe the way(s) in which these processes may be impaired in PWA. We will also present a theoretical model of cognitive processes involved in decision-making and discuss the potential clinical implications of cognitive impairments on decision-making in PWA. Main contribution: This paper provides a theoretical foundation to support future discussions and investigations of decision-making in PWA. Conclusions: Making a rational decision may be more challenging for PWA, given the possibility of concomitant cognitive impairments. Future research is needed to validate or refute the theoretical synthesis presented in this paper. This could be accomplished through a variety of qualitative, quantitative, and mixed-methods research studies.

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Ethical Concerns Caring for the Stroke Patient

Mahanes

2020

Critical Care Nursing Clinics of North America

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Decision-making capacity and aphasia: speech-language pathologists’ perspectives

Cited by 19 publications

References 20 publications

Decision-making capacity in aphasia: SLT’s contribution in England

Decision-making capacity in aphasia: SLT’s contribution in England

Decision-making, cognition, and aphasia: developing a foundation for future discussions and inquiry

Ethical Concerns Caring for the Stroke Patient

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