From the Guidelines
Patient capacity can be questioned when there are concerns about a person's ability to make informed decisions about their healthcare, particularly in situations where they demonstrate difficulty understanding relevant information, appreciating its significance, reasoning about treatment choices, or communicating their decision, as highlighted in the most recent study by 1. When assessing patient capacity, healthcare providers should consider the specific decision at hand and the patient's ability to make that decision, as capacity is decision-specific and time-specific, meaning a patient may have capacity for some decisions but not others, and capacity may fluctuate over time depending on their condition, as noted in 1 and 1. Some specific situations that might trigger capacity assessment include:
- Sudden changes in mental status
- Refusal of seemingly beneficial treatment
- Consent to high-risk procedures when clearly confused
- Psychiatric conditions affecting thought processes
- Neurological conditions impairing cognition Healthcare providers should assess capacity using tools like the Mini-Mental State Examination or more formal capacity assessments when these concerns arise, as recommended in 1 and 1. The threshold for capacity should be proportional to the risk involved in the decision - higher-risk decisions require greater demonstrated capacity, as emphasized in 1 and 1. Early identification of capacity concerns allows for appropriate interventions, including involving surrogate decision-makers when necessary, to ensure patient autonomy is respected while providing appropriate care, as discussed in 1.
From the Research
Capacity Assessment
A patient's mental capacity can be questioned in various situations, including:
- When there is an abrupt change in mental status 2, 3
- When a patient refuses a clearly beneficial recommended treatment 2
- When a patient has risk factors for impaired decision making, such as dementia or chronic mental illness 4, 5, 6
- When a patient readily agrees to an invasive or risky procedure without adequately considering the risks and benefits 2
- When a patient has a known mental disability, such as intellectual disabilities 4
Decision-Making Abilities
The assessment of a patient's decision-making abilities is crucial in determining their capacity. This includes evaluating their:
- Ability to understand information about treatment 4, 5, 2, 3
- Ability to appreciate how that information applies to their situation 4, 5, 2, 3
- Ability to reason with that information 4, 5, 2, 3
- Ability to make a choice and express it 4, 5, 2, 3
Evaluation Methods
Capacity evaluations can be performed using: