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

Abstract

Introduction The aim of the study was to explore occupational therapy practices regarding decision‐making capacity assessment and to examine factors that impact on engagement in this area. Methods Occupational therapists in Ireland were invited to participate in a cross‐sectional online questionnaire. Results One hundred and seventy‐two occupational therapists responded. 65.77% (n = 98) reported that occupational therapy plays an important role in capacity assessment in their workplace. Occupational therapists most frequently contributed to decision‐making capacity assessment for independent living (79.19%, n = 118), driving (45.89%, n = 67) and financial management (44.44%, n = 64). Many participants reported that this is more difficult than other aspects of practice and that they are not satisfied with decision‐making capacity assessment procedures in their workplace. A large majority (91.86%, n = 113) reported occupational therapists would benefit from additional training and practice guidelines in the area of decision‐making capacity assessment. Conclusion The study confirms that occupational therapists have a role to play in the multi‐disciplinary assessment of decision‐making capacity. The results of the survey suggest that decision‐making capacity assessment is complex and challenging. Factors such as confidence, education and training impact on engagement with this area of practice. There is a need to develop education resources and guidelines for occupational therapists.

Assessment of older adults' decision‐making capacity in relation to independent living: A scoping review

“…The initial inclusion criteria, search strategy, approaches to study screening and data extraction were stipulated a priori in a published protocol (Usher & Stapleton, 2020b). However, due to the iterative nature of the research and findings from an earlier study (Usher & Stapleton, 2020a), the focus of this review was refined to focus on the DMC domain of IL; therefore, the revised methods are described below.…”

“…Though legal definitions of DMC vary internationally, most legislation and literature pertaining to DMC generally define DMC for any domain in terms of four widely accepted criteria: understanding, appreciation, reasoning and expression of choice (Grisso & Appelbaum, 1998). In relation to DMC for IL, the majority of publications in this review advocate for a functional approach to DMC assessment, incorporating these four dimensions, namely, the assessment of the person's abilities to understand relevant information about the situation, appreciate how relevant information applies to oneself in the situation, engage in rational deliberation about available options and to make and communicate a choice (Brindle & Holmes, 2005;Carrese, 2006;Clionsky et al, 2016;Cooney et al, 2004;Darzins, 2010;Emmett et al, 2013;Hughes et al, 2015;Jayes et al, 2017;Mackenzie et al, 2008;Mills et al, 2014;Naik, 2017a;Naik, Lai, et al, 2008;Stewart et al, 2005;Usher & Stapleton, 2020a).…”

“…Although DMC assessment is a pertinent practice issue, poor understanding of DMC, lack of training, limited resources and time pressures pose many challenges for health and social care professionals (HSCPs) when conducting DMC assessment (Donnelly et al, 2018;Jayes et al, 2017;Lamont et al, 2017;Usher & Stapleton, 2020a). Bremault-Phillips et al (2018) recommended DMC assessment processes be standardised and integrated into routine care to enable HSCPs optimise person-centred outcomes that are least restrictive for those whose DMC is in question.…”

“…Bremault-Phillips et al (2018) recommended DMC assessment processes be standardised and integrated into routine care to enable HSCPs optimise person-centred outcomes that are least restrictive for those whose DMC is in question. In Ireland, professional concerns exist regarding the implementation of legislation, which, due to its broad application, requires development of decisionmaking support services, codes of practice, training and advance care planning frameworks (Kelly, 2017;Ní Shé et al, 2020;Usher & Stapleton, 2020a). Independent living (IL) is one of eight DMC domains identified by as requiring assessment among older adults.…”

“…IL DMC requires a person to have knowledge and understanding of what is required to live independently and the ability to apply this knowledge, to problem solve and have an appreciation of the consequences of potential choices (ABA-APA, 2008). Research on DMC assessment practices of occupational therapists in Ireland found that IL was the domain of DMC most frequently assessed among older adults (Usher & Stapleton, 2020a). However, there is no guidance for HSCPs on how best to assess a person's DMC for IL.…”