Developing a Decision-Making Capacity Assessment Clinical Pathway for Use in Primary Care: a Qualitative Exploratory Case Study

Abstract

Background 
 With an ageing population, the incidence of dementia will in­crease, as will the number of persons requiring decision-making capacity assessments. For over 10 years, we have trained family physicians in conducting decision-making capacity assessments. Physician feedback post-training, however, has highlighted the need to integrate the decision-making capacity assessment process into the primary care context. The purpose of this study was to develop a decision-making capacity as­sessment clinical pathway for implementation in primary care.
 Methods 
 A qualitative exploratory case-study design was used to ob­tain participants’ perspectives regarding the utility of a visual algorithm detailing a decision-making capacity assessment clinical pathway for use in primary care. Three focus groups were conducted with family physicians (n=4) and allied health professionals (n=6) in two primary care clinics in Alberta. A revised algorithm was developed based on their feedback.
 Results 
 In the focus groups, participants identified inconsistencies and a lack of standardization regarding decision-making capacity assessments within primary care, and provided feedback regarding a decision-making capacity assessment clinical pathway to make it more applicable to primary care. Participants described this pathway as appealing and straight­forward; they also made suggestions to make it more primary care-centric. Participants indicated that the presented pathway would improve teamwork and standardization of decision-making capacity assessments within primary care.
 Conclusions 
 Use of a decision-making capacity assessment clinical path­way has the potential to standardize decision-making capacity assessment processes in primary care, and support least in­trusive and least restrictive patient outcomes for community-dwelling older adults.

Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital

“…When the problem is not solved, a formal Capacity Interview is conducted, after which problems are further addressed, additional referrals potentially made, and legal paperwork completed as required. See Figure 1 [13].…”

“…Workshops aimed at educating participants on the application of the DMCA Model have been provided to allied HCPs and physicians since 2006 by family physicians certified in the Care of the Elderly and HCPs. The DMCA Model and education have been adapted for different disciplines and settings [10][11][12][13]. A feasibility study looking at three acute-care sites in Edmonton confirmed that this process addressed the issues of lack of knowledge, skill set, etc.…”