Mental capacity legislation and communication disability: A cross‐sectional survey exploring the impact of the COVID‐19 pandemic on the provision of specialist decision‐making support by UK SLTs

Abstract

Background: Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID-19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision-making. Aims: To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic.Methods & Procedures: This descriptive, cross-sectional study used an online survey to collect quantitative and qualitative data about SLTs' practice experiences between August and November 2020. SLTs working with a range of adult clinical populations in different care settings were sampled purposively from all UK jurisdictions. Participants were recruited through professional networks and social media. Quantitative data were summarized using descriptive statistics. Qualitative data were analysed thematically.Outcomes & Results: Data were collected from 107 SLTs working in a range of settings across all four UK nations. The sample included SLTs working with people with neurological conditions, learning disabilities, mental health conditions and acute confusion. The need for SLT support appeared to increase during the pandemic. Most respondents were still able to offer support; however, the amount and nature of support varied. Quality of support was impacted by adjustments associated with social distancing and infection control restrictions. Personal protective equipment (PPE) was identified as a barrier to communication. Indirect working methods (e.g., telehealth) were inaccessible to some people with communication disabilities. Most respondents felt confident that legal requirements were upheld, but suggested this group was less able to engage in 172

Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19

“…A study by Porteny et al, described how clinicians perceived an increased patient willingness to discuss quality of life and ACP due to COVID-19, but patients reported minimal engagement in such discussions [ 37 ]. This discrepancy was further exacerbated by challenges such as PPE hindering communication [ 44 ], remote discussions [ 42 ], and disparities in ACP knowledge across different communities [ 57 ].…”

“…However, palliative care consultations showed a positive correlation with ACP documentation [ 36 , 40 ], indicating the role of such consultations in the ACP process. The pandemic spurred an earlier initiation of ACP conversations, often influenced by media coverage and public awareness [ 45 ], but the quality of these discussions varied, with telemedicine emerging as a key but imperfect tool [ 43 , 44 ]. The variability in treatment intensity for patients with dementia [ 41 ] and the challenges in involving patients in shared decision-making [ 62 ] suggest that provider biases and systemic issues in healthcare communication persist.…”

“…Similarly, the necessity for PPE created a further physical barrier between healthcare providers and patients [ 39 , 40 , 44 , 48 , 53 ]. This not only made communication more challenging but also added an impersonal element to clinical interactions, which, in the context of ACP, are typically highly sensitive and personal.…”

A bibliometric analysis of linguistic research on COVID-19

“…When a society faces a crisis like the COVID-19 pandemic, the impact of COVID-19 on special needs populations, such as people with dysphagia or aphasia or hearing impairments (Cheng and Cheng, 2022 ; Mathews et al, 2022 ), assumes greater importance for the linguistic community. A study by Jayes et al ( 2022 ) described how UK Speech and language therapists (SLTs) supported differently abled individuals with communication disabilities to make decisions and participate in mental capacity assessments, best interest decision-making, and advance care planning during the COVID-19 pandemic. Govender et al ( 2021 ) investigated how people with a total laryngectomy (PTL) were impacted by COVID-19.…”

Impact of the initial COVID-19 response in the UK on speech and language therapy services: a nationwide survey of practice

“…Nonetheless, the uptake of telehealth in speech and language therapy inevitably increased during the pandemic in the UK (Charlton et al. , 2023; Jayes et al. , 2022; Patel et al.…”