126 PCN Capacity Evaluation

Criterion: Understanding

Patient Ability: grasp fundamental meaning of information communicated
Assessment Approach: encourage paraphrasing of disclosed information regarding condition and treatment
Sample Questions: “please tell me in your own words…”:

  • “the problem with your health now”
  • “the recommended treatment”
  • “the possible risks and benefits of the treatment”
  • “any alternative treatments and their risks/benefits”
  • “risks and benefits of no treatment”
Comment: information to be understood includes nature of condition, nature and purpose of proposed treatment, possible risks and benefits of that treatment, and alternative approaches – including no treatment

Criterion: Appreciation

Patient Ability: acknowledge medical condition and likely consequences of treatment options
Assessment Approach: ask for description of perspective on medical condition, proposed treatment, likely outcomes
Sample Questions:
  • “what do you believe is wrong with your health now?”
  • “do you believe that you need some kind of treatment?”
  • “what is treatment likely to do for you?”
  • “what makes you believe it will have that effect?”
  • “what do you believe will happen if you are not treated?”
  • “why do you think (this treatment) has been recommended?”
Comment: consider that patients who do not recognize their illnesses (“lack of insight”) cannot make valid decisions about treatment; delusions or pathologic levels of distortion or denial are the most common causes of impairment in this criterion

Criterion: Deliberation/Reasoning

Patient Ability: demonstrate rational process of manipulating the relevant information
Assessment Approach: ask for comparison of treatment options/consequences and reasons for choice
Sample Questions:
  • “how did you decide to accept or reject the recommended treatment?”
  • `“what makes (chosen option) better than (alternative option) for you?”
Comment: focus on process of decision-making, not outcome; patients have right to make “unreasonable” choices

Criterion: Communication

Patient Ability: clearly indicate a treatment choice
Assessment Approach: ask patient to identify/indicate a treatment choice
Sample Questions:
  • “have you decided to follow a recommendation for treatment?” “can you tell me what that decision is?” OR
    • “what is making it hard for you to decide”
Comment: frequent reversals of choice because of psych/neuro conditions may indicate lack of capacity”

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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