Evaluation of decision-making capacity in patients with dementia: challenges and recommendations from a secondary analysis of qualitative interviews.
Autonomy
Competence
Decision-making capacity
Dementia
Ethics
Informed consent
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
06 07 2020
06 07 2020
Historique:
received:
19
02
2019
accepted:
26
06
2020
entrez:
8
7
2020
pubmed:
8
7
2020
medline:
29
7
2021
Statut:
epublish
Résumé
Evaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, we provide recommendations for such evaluations in clinical practice. We used thematic coding to analyse physicians' narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation. In this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation. Upon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process.
Sections du résumé
BACKGROUND
Evaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, we provide recommendations for such evaluations in clinical practice.
METHODS
We used thematic coding to analyse physicians' narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation.
RESULTS
In this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation.
CONCLUSIONS
Upon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process.
Identifiants
pubmed: 32631304
doi: 10.1186/s12910-020-00498-y
pii: 10.1186/s12910-020-00498-y
pmc: PMC7339476
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
55Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
ID : 406740_139294
Pays : International
Références
Prog Neurobiol. 2013 Nov;110:102-13
pubmed: 23578568
J Psychiatr Res. 1975 Nov;12(3):189-98
pubmed: 1202204
Am J Psychiatry. 2006 Aug;163(8):1323-34
pubmed: 16877642
Nurs Ethics. 2007 Jan;14(1):27-40
pubmed: 17334168
JAMA. 2013 Apr 24;309(16):1689-90
pubmed: 23568671
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):920-925
pubmed: 29851885
Am J Alzheimers Dis Other Demen. 2015 Jun;30(4):360-3
pubmed: 24946784
J Am Med Dir Assoc. 2005 May-Jun;6(3 Suppl):S100-4
pubmed: 15890283
Gerontologist. 2004 Apr;44(2):166-75
pubmed: 15075413
Ann Intern Med. 2011 Mar 1;154(5):336-46
pubmed: 21357911
Health Care Anal. 2004 Dec;12(4):251-63; discussion 265-72
pubmed: 15658081
Can Fam Physician. 2017 Jan;63(1):e21-e30
pubmed: 28115457
Ann Indian Acad Neurol. 2016 Oct;19(Suppl 1):S34-S39
pubmed: 27891023
Sociol Health Illn. 2003 Nov;25(7):768-92
pubmed: 19780205
Neurology. 2000 Apr 25;54(8):1616-25
pubmed: 10762503
Dementia (London). 2019 Oct-Nov;18(7-8):2821-2835
pubmed: 29512408
Med Health Care Philos. 2020 Jun;23(2):253-259
pubmed: 32350707
Med Humanit Rev. 1987 Jan;1(1):78-82
pubmed: 11621442
Int J Palliat Nurs. 2017 Jan 2;23(1):4-11
pubmed: 28132606
JAMA. 2011 Jul 27;306(4):420-7
pubmed: 21791691
Front Psychol. 2016 May 26;7:765
pubmed: 27303329
Gerontology. 2020;66(1):40-46
pubmed: 31212289
J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):382-7
pubmed: 14966152
Lancet. 2005 Dec 17;366(9503):2112-7
pubmed: 16360788
J Am Geriatr Soc. 1998 Jul;46(7):922-6
pubmed: 9670887
Swiss Med Wkly. 2018 Dec 30;148:w14706
pubmed: 30594990
N Engl J Med. 2007 Nov 1;357(18):1834-40
pubmed: 17978292
J Law Med Ethics. 2017 Mar;45(1):95-105
pubmed: 28661281