9th March 2018, Volume 131 Number 1471

Greg Young, Alison Douglass, Lorraine Davison

Assessing decision-making capacity (‘capacity’) is an essential skill for all doctors in clinical practice, not least because it is integral to obtaining informed consent to treatment.1 Capacity is the legal…

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Summary

All doctors need to know how to assess a patient’s capacity to make decisions so that they can get informed consent for medical procedures, but also to support a patient who may have a condition that impairs their cognition and who needs to make an important decision, but may not be able to do so. Such patients are vulnerable and need support. We did a survey of hospital doctors of all grades and of GPs to assess what they knew about capacity assessment, whether they wanted to learn more, and what format of teaching they preferred. The majority of respondents could recall seeing a patient with suspected problems with capacity in the previous year, mostly due to cognitive disorders like dementia. There were significant gaps in the respondents’ knowledge about capacity assessment, and the respondents described a range of difficulties they perceived with doing capacity assessment. Tutorials, internet-based learning and workshops were equally popular educational methods.

Abstract

Aim

To survey hospital doctors (HDs) and general practitioners (GPs) on what they know about assessing capacity, and to determine their educational needs.

Method

A mixed-methods, cross-sectional survey was administered to a convenience sample of HDs and GPs. Respondents were asked about their roles, the prevalence of older patients they had seen, specific questions about capacity assessment, difficulties encountered and their preferred format for further education.

Results

152/980 (15%) HDs and 74/4,000 (2%) GPs responded. Most had been concerned about a patient’s capacity in the past year, but had not received training in assessing capacity since graduation. The average responder scored below 70% on knowledge questions. Lack of legal knowledge and time pressures were among difficulties encountered. One-third of respondents lacked confidence to assess capacity to a standard high enough to present in court. Many doctors were willing to improve their skills, requesting tutorials or short courses.

Conclusion

Respondents demonstrated gaps in their knowledge on assessing capacity, and a lack of confidence in their opinions. The findings of this survey suggest that further clinical and legal education of doctors in performing capacity assessments would be valuable.

Author Information

Greg Young, Consultant Psychiatrist, Capital and Coast DHB, Hawkes Bay; 
Alison Douglass, Barrister, 2014 recipient of the New Zealand Law Foundation International Research Fellowship, Dunedin; Lorraine Davison, Psychiatry Registrar, Capital and Coast DHB, Wellington.

Acknowledgements

the authors gratefully acknowledge support for this project from the New Zealand Law Foundation.

Correspondence

Dr Greg Young, Te Korowai Whariki, Capital and Coast District Health Board.

Correspondence Email

greg.young@ccdhb.org.nz

Competing Interests

Dr Young reports that the statistical analysis for the study was supported by a grant from New Zealand Law Foundation.

References

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