Medical Decision-making Capacity Assessment - #60Take Quiz
Determine an older adult’s ability to make medical decisions in a hospital or clinic setting.
Medical decision-making capacity is the ability “to understand information relevant to a treatment
decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision.”2 Capacity and competency both refer to one’s ability to make decisions, but there are key distinctions. 60-1
In general, four elements must be present for a person to have medical decision-making capacity (see column on left, below).3,4 When assessing capacity, address each area during the interview. 60-2
Many tools exist to assist in assessment of decision-making capacity. The following are commonly used, reliable, and feasible to perform in an office setting: Aid to Capacity Evaluation (ACE), Hopkins Competency Assessment Tool (HCAT), and Understanding Treatment Disclosure (UTD)1.
When assessing capacity, providers must consider multiple factors that may influence responses. 60-3
Apply the four key abilities required for decision-making capacity to the patient interview and determine whether an elderly adult has capacity to make a given medical decision.
- Describe the differences between decision-making capacity and competency.
- Name the four abilities an individual must demonstrate to have decision-making capacity.
- Describe observable patient behaviors that demonstrate these abilities.
- Identify available tools to facilitate capacity assessment.
- Evaluate a patient for factors that may confound capacity assessment.
- Appreciate the fluid nature of capacity assessment and the need to re-evaluate over time
1. Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? Journal of the American Medical Association 2011; 306(4): 420-427.
2. Etchells E, Sharpe G, Elliot C, Singer PA. Bioethics for clinicians: Capacity. Canadian Medical Association Journal 1996; 155 (6): 657-661.
3. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. New England Journal of Medicine 1988 Dec 22; 319(25): 1635-1638.
4. Tunzi M. Can the patient decide? Evaluating patient capacity in practice. American Family Physician 2001; 64: 299-306.
5. Carling-Rowland, Alexandra. (2012). Communication aid to capacity evaluation (CACE). Available at: http://www.aphasia.ca/home-page/health-care-professionals/resources-and-tools/cace/ Accessed 5/11/2016.
6. Okai D, Owen G, McGuire H, Singh S, Churchill R, Hotopf M. Mental capacity in psychiatric patients: systematic review. British Journal of Psychiatry 2007; 191: 291-297.
7. Arozullah AM, Yarnold PR, Bennett CL, Soltysik RC, Wolf MS, Ferreira RM, Lee SD, Costello C, Shakir A, Denwood C, Bryant FB, Davis T. Development and Validation of a Short-Form, Rapid Estimate of Adult Literacy in Medicine. Medical Care 2007; 45: 1026-1033.
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