Essential components of a capacity-determination interview
Posted by dkwinter

 

1. Mental Status

 

2. Judgement

  1. “What would you try to do if they saw a bottle that was rolling across a table?”
  2. “If you were walking along a sidewalk and found a stamped-and-addressed envelope sitting on the sidewalk, what would you do with it?”

 

3. Decision-making capacity

  • Understanding
    • States the meaning of relevant info
      • E.g. dx, risks/benefits of procedure, indications, and options of care
      • “Can you tell me in your own words what I just said about ”
    • Impaired in: problems with memory, attention span, intelligence; advanced dementia
  • Appreciation
    • Explains how information applies to oneself
      • “Regardless of what your choice is, do you think it is possible the medication can harm you?”
      • “Regardless of what your choice is, do you think that it is possible the medication can benefit you?”
      • “Can you tell me in your own words what you see as your medical problem?”
    • Impaired in: denial; delusional disorder; advanced dementia
  • Reasoning
    • Can compare information and infer consequences of choices.
      • “How could X affect your daily activities?”
      • “How is X better than Y?”
      • Impaired in: depression; psychotic thought disorder; anxiety; phobia; delirium; advanced dementia
  • Expressing a choice
    • States a decision
    • Impaired in: psychiatric disorders; extreme (pathologic) indecision; advanced dementia