What is best practice when conducting the decision-making capacity
assessment of patients in the hospital?
Abstract
The capacity to make reasoned decisions about one’s health care is
central to optimal person-centered care. Termed ‘decision-making
capacity’, it requires comprehension of the information presented about
one’s health, an understanding of one’s circumstances and the reasoning
skills to navigate health care options. Impaired decision-making
capacity is prevalent in hospital settings whilst also being
under-recognized leading to sub-optimal care and raising ethical
concerns. This assesses decision-making capacity all the more important
in this setting. This scoping review aimed to explore and summarise the
literature on current practice in the assessment of decision-making
capacity in hospital settings. A total of four databases (Psychinfo,
CINAHL, Scopus and Medline) were searched from 2009 to June 2019, using
search terms related to ‘assessment’, ‘decision-making capacity’ and
‘patient’. Thirteen studies were included. They investigated a variety
of methods for assessing decision-making capacity in hospital settings.
No gold standard test emerged. Commonly, it was doctors that assessed
decision-making capacity with an informal interview with the patient;
however, the error rate for this assessment was up to 58%. The
literature suggests that training in this method and/or the use of more
structured assessment tools may be required to improve the accuracy of
decision-making capacity assessment. Another finding was that
decision-making capacity assessments rely heavily on patient
communication abilities. Therefore, all efforts should be made to
provide communication assistance, for support with patients who have
complex communication needs (including engagement with Speech and
Language Pathology services). Finally, healthcare services must ensure
health professionals performing capacity assessments receive appropriate
training and that robust policy are in place to support improved
assessment practices.