Giving voice to people with communication disabilities during mental capacity assessments

Abstract

Background: Healthcare professionals without specialist training in communication disorders may not know how to identify and support patients with communication disabilities during mental capacity assessments. To meet this need, a novel communication screening tool was developed and tested as part of a mental capacity assessment support toolkit. Aims: To provide an initial evaluation of the communication screening tool's usability, interrater reliability and criterion validity. Methods & Procedures: A prototype communication screening tool was developed iteratively using co-production and user-centred design principles. A mixed-methods case series design was used to explore how multidisciplinary healthcare professionals used the tool to test patients in acute hospital and intermediate care settings. Usability data were collected in an electronic survey and from a documentary analysis. Screening test outcomes obtained by pairs of professionals were compared to measure the tool's interrater reliability. Outcomes obtained by professionals were compared with the outcomes of a speech and language therapist's communication assessment to measure criterion validity. Quantitative data were analysed using frequency counts and inferential statistics. Qualitative data were analysed using framework analysis. Outcomes & Results: A total of 21 professionals, including physicians, nurses, occupational therapists, physiotherapists, and speech and language therapists, and 17 patients with diagnoses of stroke or cognitive impairment took part. Professionals reported they found the tool easy to use, useful and that its use increased their understanding of communication support methods and the speech and language therapist role in relation to mental capacity assessment. However, not all used it consistently or accurately. Professionals reported they chose not to use the tool when they perceived patients' communication to be intact. Four of eight patients with a diagnosis of dementia or memory impairment, who professionals elected not to screen, were found to have significant communication needs. Screening outcome data for nine patients suggest the tool's interrater reliability is currently moderate, whilst its criterion validity is poor. Conclusions & Implications: This study highlights that non-speech and language therapist health professionals have difficulty identifying and screening for communication difficulties. This confirms existing evidence that people with communication disabilities may not receive the decision-making support they require during mental capacity assessments when speech and language therapists are not involved. Greater understanding of health professionals' thought processes regarding communication is required to further develop this unique communication screening tool so that it can effectively enable healthcare professionals to identify and use communicative adaptations to support decision-making.

How are adults with capacity-affecting conditions and associated communication difficulties included in ethically sound research? A documentary-based survey of ethical review and recruitment processes under the research provisions of the Mental Capacity Act (2005) for England and Wales

“…However, despite attempts to use familiar vocabulary to accommodate participants with CCDs, lower levels of concreteness, imageability and readability persisted. The different skillsets and professional backgrounds of the researchers devising the resources might be factors here 31. In some cases, resources were the result of collaboration with people with relevant lived experience bringing authenticity.…”

“…The different skillsets and professional backgrounds of the researchers devising the resources might be factors here. 31 In some cases, resources were the result of collaboration with people with relevant lived experience bringing authenticity. However, this does not necessarily assure a suitably reduced cognitive load for prospective participants.…”

Supported decision‐making and mental capacity assessment in care homes: A qualitative study

“…The toolkit also contains specific resources to enable HSCPs to identify and support the decision‐making needs of individuals with communication difficulties. This is a legal requirement, but something that HSCPs without specialist knowledge and training in communication disorders find challenging (Jayes et al., 2021). MCAST includes a Communication Screening Tool, designed to enable HSCPs to identify rapidly whether to refer an individual to a speech and language therapist (SLT) for specialist assessment and support.…”

Co-designing care for multimorbidity: a systematic review

“…1 ). The most common reasons for exclusion were due to projects targeting single conditions or problems [ 20 , 21 ], or using a non-co-design methodology to develop an intervention. In several cases, the intervention development process was not reported [ 22 ].…”