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

Abstract

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

How do health and social care professionals in England and Wales assess mental capacity? A literature review

“…Another potential factor influencing choice of assessor related to the knowledge and skills required to complete capacity assessments for specific types of patient. For example, SLTs might be involved in assessments for people with communication difficulties [36,40]. Two studies [36,38] described the involvement of mental health specialists (e.g., liaison psychiatrists or mental health nurses) in capacity assessments for patients with mental health conditions.…”

“…Williams et al [52] identified that, at times, professionals did not appear to take steps to support the communication needs of people with learning disabilities. Furthermore, the routine involvement of SLTs in supporting people with communication needs during capacity assessments appeared inconsistent and perhaps dependent on other professionals being aware of the nature of communication needs and the types of support SLTs could offer [36,40].…”

“…The interventions described in this review were designed for local use and do not appear to have been implemented more widely. Studies reported that some professionals had not received training in mental capacity assessment or felt their training needed to be updated [40]. Professionals who had received training reported that they still found capacity assessment challenging [36] and that they would benefit from additional training, especially if it involved discussions about clinical scenarios [39] and practical aspects of assessment [33].…”

Occupational therapy and decision‐making capacity assessment: A survey of practice in Ireland

“…While Jayes et al () reported that the choice of which MDT members assess capacity may often be decided on perceptions of professional hierarchy and responsibility, it should be guided on the basis of which HCP has more knowledge, skill or information about the decision and the patient. For example, speech and language pathologists have emphasised their specialist skills and their role for people with communication difficulties like aphasia (Aldhous et al, ; McCormick et al, ; Suleman & Kim, ). Therefore, it is not surprising in this study that occupational therapists reported significant involvement in DMC assessment regarding independent living, and less so in other areas, such as sexual consent.…”

“…Following a review of literature examining health and social care professionals practice in the area of decision-making capacity, a questionnaire was developed. The survey questions were informed by surveys used in previous studies that had investigated the assessment of decision-making capacity by lawyers (Helmes, Lewis, & Allan, 2004), neuropsychologists (Mullaly et al, 2007), speech-language pathologists (Aldous, Tolmie, Worrall, & Ferguson, 2014;Jayes et al, 2017;McCormick, Bose, & Marinis, 2017) and non-specified health-care practitioners (Lamont et al, 2017). These items were contextualised to fit within occupational therapy practice and addressed the domains of DMC assessment defined by Moye and Marson (2007…”