From the Guidelines
Capacity assessment involves evaluating four key elements to determine if a patient can make informed healthcare decisions, including understanding, appreciation, reasoning, and expression of choice, as outlined in the most recent and highest quality study 1. The steps of capacity assessment are crucial in evaluating a patient's ability to make informed decisions about their own care.
Key Elements of Capacity Assessment
- Assess if the patient can understand relevant information about their condition, treatment options, and potential outcomes.
- Evaluate their ability to appreciate how this information applies to their specific situation and the consequences of their choices.
- Determine if they can reason through the decision-making process by comparing options and weighing risks and benefits.
- Confirm they can communicate their choice consistently. This assessment should be decision-specific rather than global, as capacity may vary depending on the complexity of the decision, as noted in 1.
Evaluation and Documentation
The evaluation typically involves asking open-ended questions about the proposed treatment, alternatives, risks, benefits, and reasoning behind the patient's choice. Documentation should include specific observations of the patient's responses rather than just conclusions. If capacity is questionable, consider consulting psychiatry or ethics, addressing reversible causes of impaired decision-making, and reassessing over time as capacity may fluctuate, as recommended in 1. Remember that capacity assessment respects patient autonomy while ensuring vulnerable patients receive appropriate protection when they cannot make informed decisions, as emphasized in 1 and 1. Capacity is issue-specific, and patients may have capacity to consent to simple procedures but not complex ones, as highlighted in 1 and 1. A lack of decision-making capacity may be the predictable result of a condition, the temporary result of an event, or the permanent result of an event, as discussed in 1 and 1.
From the Research
Steps of Capacity Assessment
The steps of capacity assessment in evaluating a patient's ability to make informed decisions about their own care include:
- Assessment of the patient's ability to communicate 2
- Determination of the patient's understanding of the proposed care 2
- Evaluation of the patient's rationale for decisions about that care 2 These steps are part of a focused and impartial evaluation of mental status and medical, surgical, psychiatric, and psychosocial histories 2.
Tools for Capacity Assessment
Various tools can be used to assess a patient's capacity, including:
- Mini-Mental State Examination (MMSE) 3, 4, 5
- Montreal Cognitive Assessment (MoCA) 3, 5 These tools can help evaluate a patient's cognitive function and ability to make informed decisions.
Importance of Capacity Assessment
Capacity assessment is crucial in ensuring that patients receive the care they need, especially when they are deemed to lack capacity 2. Mechanisms should be in place to ensure that patients who lack capacity receive the necessary care and support.
Additional Considerations
Other types of assessments, such as functional capacity evaluations, can also be used to measure an individual's maximal work abilities 6. However, these assessments may not be directly relevant to evaluating a patient's ability to make informed decisions about their own care.