Assessment of decision-making capacity: views and experiences of consultation psychiatrists

Psychosomatics. Mar-Apr 2013;54(2):115-23. doi: 10.1016/j.psym.2012.08.001. Epub 2012 Nov 27.

Abstract

Background: Decision-making capacity (DMC) assessments can have profound consequences for patients. With an aging population, an increasing emphasis on shared decision-making, and a rising number of potential medical interventions, the need for such assessments will continue to grow.

Objective: To assess psychosomatic medicine clinicians' training, experiences, and views about DMC assessments.

Method: Online survey of members of the Academy of Psychosomatic Medicine (APM). Of 780 eligible members, 288 responded to the survey (36.9% response rate).

Results: Approximately 1 in 6 psychiatric consultations are DMC assessments. Ninety percent of respondents reported that at least half of their capacity assessments involve patients older than 60 years. DMC assessments were seen as more challenging and time-consuming than other types of consultations; yet training in capacity evaluations was seen as suboptimal and half of respondents felt the evidence-base guiding DMC assessment is somewhat or much weaker than for other types of psychiatric consultations. In addition, the practice of capacity assessment seems to vary widely with no consistent approach among respondents. Respondents strongly endorsed multiple areas and topics for potential future research, indicating a desire for a stronger evidence-base.

Conclusions: Members of the APM perceive capacity assessments as common and challenging. Yet they perceive having received subpar training with relatively weak evidence to guide their current practice. Future research should address these potential deficiencies, given the likelihood that DMC assessments will only become more common.

MeSH terms

  • Aged
  • Attitude of Health Personnel*
  • Canada
  • Clinical Competence / standards
  • Data Collection
  • Decision Making*
  • Evidence-Based Medicine / standards
  • Female
  • Humans
  • Informed Consent / psychology*
  • Male
  • Mental Competency / psychology*
  • Middle Aged
  • Psychosomatic Medicine / standards*
  • Referral and Consultation / standards
  • Regression Analysis
  • Societies, Medical
  • United States