Essential components of a capacity-determination interview
Posted by dkwinter

Patients may lack the capacity to process decisions. This can be due to intoxication from drugs or alcohol, brain injury or psychiatric illness.

Such patients' safety is paramount. Sometimes they need to be detained in a hospital for assessment.

 

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