Can a patient with potential cognitive or visual impairments and underlying medical conditions review their assessment and treatment plan?

Patient Review of Assessment and Treatment Plans

Yes, patients should review their assessment and treatment plans, but this must be adapted based on cognitive and visual capabilities, with caregiver involvement when impairments exist. 1

Assessment of Patient Capacity to Review Plans

Before sharing assessment and treatment plans, clinicians must evaluate factors that affect the patient's ability to understand and engage with medical information:

• Cognitive function screening is mandatory using validated tools like the Mini-Cog (scores 0-2 indicate high likelihood of impairment requiring modified communication strategies). 1
• Document cognitive impairment through formal mental status assessment or qualitative statements, as this directly impacts how information should be presented. 1
• Visual disturbances must be identified, including blindness, partial blindness, or macular degeneration, which necessitate alternative formats for written materials. 1
• Low literacy skills require assessment, as patients who cannot read or write well need verbal explanations and simplified materials rather than complex written plans. 1
• Language preferences should be documented to ensure materials are provided in the patient's preferred language for communication. 1

Modified Communication Strategies for Impaired Patients

When cognitive or visual impairments are present, standard plan review processes must be adapted:

• Provide explicit and written instructions for appointments, medications, and treatments when cognitive impairment is suspected (Mini-Cog scores 0-2). 1
• Elicit input from a trusted confidant or caregiver about the patient's cognition and involve them in reviewing the treatment plan. 1
• Assess decision-making capacity and obtain health care proxy information if the patient lacks capacity to understand the assessment and plan independently. 1
• Ensure patients wear corrective devices (glasses, hearing aids) during plan review sessions to maximize comprehension. 1
• Adapt tools and materials for patients with communication limitations such as aphasia or other language disorders. 1

Structured Approach to Plan Review

The review process should follow a patient-centered framework:

• Establish shared goals through collaborative partnership between clinician, patient, and care partner before presenting the assessment and plan. 1
• Use patient-centered communication to develop understanding of the evaluation process and treatment recommendations. 1
• Provide information that is concise, clear, and illustrated with graphics when appropriate, as patients prefer permanent records of personal health data. 2
• Include family members in care to facilitate learning and behavior change, particularly when cognitive or visual impairments exist. 1
• Ensure physical comfort is addressed before cognitive discussions, as uncontrolled pain interferes with understanding and engagement. 3

Documentation and Follow-Up

• Document the patient's understanding of the assessment and plan, including any barriers to comprehension identified during the review. 1
• Reassess learning readiness regularly throughout treatment, as cognitive status may change over time, particularly in patients with progressive conditions. 1, 4
• Provide written summaries that patients can reference after the visit, as this improves understanding, enhances provider relationships, and motivates adherence to treatment plans. 2
• Plan serial assessments to track evolution of symptoms and adjust the treatment plan accordingly, using the patient's feedback on their understanding and concerns. 3

Critical Pitfalls to Avoid

• Never assume normality or ascribe symptoms to "normal aging" without appropriate evaluation, even if the patient appears to understand the plan. 1
• Do not proceed without caregiver involvement when significant cognitive impairment is documented, as the patient may lack insight into their own limitations. 1, 4
• Avoid complex medical jargon and instead use patient-friendly language that matches the patient's health literacy level. 1
• Do not rely solely on written materials for patients with visual impairments or low literacy—verbal explanation with teach-back methods is essential. 1