The Development and Implementation of a Decision-Making Capacity Assessment Model

Abstract

BackgroundDecision-making capacity assessment (DMCA) is an issue of increasing importance for older adults. Current challenges need to be explored, and potential processes and strategies considered in order to address issues of DMCA in a more coordinated manner.MethodsAn iterative process was used to address issues related to DMCA. This began with recognition of challenges associated with capacity assessments (CAs) by staff at Covenant Health (CH). Review of the literature, as well as discussions with and a survey of staff at three CH sites, resulted in determination of issues related to DMCA. Development of a DMCA Model and demonstration of its feasibility followed.ResultsA process was proposed with front-end screening/problem- solving, a well-defined standard assessment, and definition of team member roles. A Capacity Assessment Care Map was formulated based on the process. Documentation was developed consisting of a Capacity Assessment Process Worksheet, Capacity Interview Worksheet, and a brochure. Interactive workshops were delivered to familiarize staff with the DMCA Model. A successful demonstration project led to implementation across all sites in the Capital Health region, and eventual provincial endorsement.ConclusionsConcerns identified in the survey and in the literature regarding CA were addressed through the holistic interdisciplinary approach offered by the DMCA Model.

Developing occupational therapists’ capabilities for decision-making capacity assessments: how does a support role facilitate workplace learning?

“…Therefore, best practice is that they are undertaken only if: 1) there is a need for a decision to be made, 2) there is a significant risk of harm, 3) all reversible conditions which may impact on decision-making have been ruled out, and 4) all less restrictive options for managing the risk of harm have been exhausted [18]. Secondly, DMCAs are interprofessional and should involve input from medical and allied health professionals who can undertake holistic evaluations of the psychological, social, cognitive, functional and medical factors, as well as a direct assessment of the per-son's decision-making process [18,19]. Finally, occupational therapists' contributions to DMCAs are valued [11,[18][19][20], particularly where there is a question about an adult's ability to make decisions about personal matters such as discharge destination or care arrangements [16].…”

“…Secondly, DMCAs are interprofessional and should involve input from medical and allied health professionals who can undertake holistic evaluations of the psychological, social, cognitive, functional and medical factors, as well as a direct assessment of the per-son's decision-making process [18,19]. Finally, occupational therapists' contributions to DMCAs are valued [11,[18][19][20], particularly where there is a question about an adult's ability to make decisions about personal matters such as discharge destination or care arrangements [16]. In these situations, occupational therapists can provide supporting evidence regarding a client's functional abilities, limitations and associated risks of harm, and implement interventions to maximize independence and minimize the risks of harm.…”

“…Several studies have demonstrated that medical and allied health professionals often lack the readiness required to perform DMCAs [13,19,[21][22][23][24][25]. These findings highlight the need for additional education, training and support.…”

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

“…Internationally, barriers to DMC assessment have been identified including lack of education and training, differing understandings of DMC, limited resources and time pressures (Charles et al, ; Jayes, Palmer, & Enderby, ; Lamont, Stewart, & Chiarella, ). A range of models for DMC assessment have been developed in other jurisdictions (Bigby & Douglas, ; Brémault‐Phillips et al, ; Parmar, Brémault‐Phillips, & Charles, ) which may enhance HCP’s ability to assess DMC. DMC assessment processes and best‐practices need to be standardised and integrated into routine care to ensure that health‐care professionals can determine person‐centred outcomes that are least restrictive and intrusive (Brémault‐Phillips et al, ).…”

Characteristics of patients referred for assessment of decision‐making capacity in the acute medical setting of an outer‐metropolitan hospital—A retrospective case series

“…As the population ages and cognitive impairment becomes more prevalent, requests for assessments of decision-making capacity are increasing in frequency and complexity. [1][2][3] Capacity is specific to the decision in question, and so a person may have capacity for some decisions but not others. 4 A determination about capacity can be confronting and intrusive.…”