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Medical Decision-Making Capacity

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1. Decision-making and mental capacity

of overt and covert coercion during decision-making. 1.3 Advance care planning Advance care planning involves helping people to plan for their future care and support needs, including medical treatment, and therefore to exercise their personal autonomy as far as possible. This should be offered to everyone who is at risk of losing capacity (for example through progressive illness), as well as those who have fluctuating capacity (for example through mental illness). Some approaches involve (...) Decision-making and mental capacity Decision-making and mental capacity Decision-making and mental capacity NICE guideline Published: 3 October 2018 nice.org.uk/guidance/ng108 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

2. Decision-making capacity of detainees in immigration removal centres (IRCs)

, 2015: points 1.5, 1.6 and 4.10). 2 One case was set aside by consent.6 http://www.rcpsych.ac.uk Position Statement PS03/17 Assessment of decision-making capacity The Home Office does not currently keep records of the frequency or outcome of capacity assessments in IRCs, so the full extent of this problem is unknown. Assessment of decision-making capacity is not a routine part of the initial or subsequent medical assessments conducted in IRCs. The report of the Shaw review into the welfare (...) is that: existing evidence (medical, legal and government reports) provides grounds for serious concerns that both pre-existing mental disorders (which are likely to be aggravated by detention) and those arising during detention may result in detainees losing decision-making capacity with regard to healthcare and legal matters; 3 the processes in place within IRCs to address these concerns are not sufficiently robust; to begin to make progress in addressing these issues, the recommendations made

2018 Royal College of Psychiatrists

3. Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science. (PubMed)

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science. Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals.This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature.Six electronic databases were (...) searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis.Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings

2018 American Journal of Hospice and Palliative Medicine

4. Shared decision making

a shared decision-making approach to care, including those of the General Medical Council, General Pharmaceutical Council and Nursing and Midwifery Council. All NICE guidance recommends shared decision making, and several NICE quality standards identify and define shared decision making as part of good quality care. The NHS England document Universal personalised care: Implementing the comprehensive model, published in January 2019 has shared decision making as 1 of the 6 core components (...) the Department of Health's advice on consent and take account of the NICE guidance on decision-making and mental capacity. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act. However, the statutory principles in the Act make clear that a person must be assumed to have capacity unless it is established that they do not. Moreover, they should not be treated as unable to make a decision merely because

2019 National Institute for Health and Clinical Excellence - Advice

5. Medical Decision-Making Capacity

Medical Decision-Making Capacity Medical Decision-Making Capacity Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Medical Decision (...) -Making Capacity Medical Decision-Making Capacity Aka: Medical Decision-Making Capacity , Decision-Making Capacity , Decision Making Capacity Evaluation From Related Chapters II. Definitions Patient willingly participates in medical therapy Requires understanding what is involved with the proposed therapy Sufficient understanding and memory to comprehend their own situation Understanding of the consequence of their proposed actions Competence is determined by a judge May indicate whether a person may

2018 FP Notebook

6. Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments (PubMed)

Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced

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2016 Frontiers in psychology

7. Twelve-month recovery of medical decision-making capacity following traumatic brain injury. (PubMed)

Twelve-month recovery of medical decision-making capacity following traumatic brain injury. To investigate recovery of medical decision-making capacity (MDC) over the first year following traumatic brain injury (TBI).A total of 177 participants (111 persons with TBI and 66 healthy controls) were recruited from an inpatient/outpatient TBI rehabilitation unit and outpatient neurology department. Participants with TBI were classified by injury severity into subgroups: mild TBI (mTBI; n = 28 (...) ), complicated mild TBI (cmTBI; n = 23), and moderate/severe TBI (msevTBI; n = 60). Control and TBI groups were compared at 1 month (t1), 6 months (t2), and 12 months (t3) postinjury using the Capacity to Consent to Treatment Instrument (CCTI), which evaluates MDC using 5 consent standards: expressing choice, reasonable choice, appreciation, reasoning, and understanding.Relative to controls, no TBI group displayed impairment on CCTI expressing choice or reasonable choice at any timepoint. Those with mTBI had

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2016 Neurology

8. Supporting Parents in Making Informed Decisions in Relation to their Children?s Health Needs

evidence and where patients are supported to consider options to achieve informed preferences) and family-centred educational programs.(6-8) However, data from recent surveys conducted in Ontario show that there remains room for improvement with regards to increasing parents’ capacity to make informed decisions. Specifically, in a survey of parents seeking care for their child in a pediatric tertiary care hospital in Ottawa, 48% of parents reported not being offered more than one treatment option (...) a reduction in decisional conflict from parents, and that the combined use of decision aids and coaching supported shared decision- making.(20) The second primary study examined the use of medication choice cards to support parent decision-making.(21) The study found that clinicians using the cards reported positive experiences, but that reliable implementation and use of the decision aids was difficult, having only been implemented in 35% of visits where starting or switching medication was discussed.(21

2018 McMaster Health Forum

9. Evidence Brief - Use of Patient Reported Outcome Measures for Measurement Based Care in Mental Health Shared Decision-Making

Evidence Brief - Use of Patient Reported Outcome Measures for Measurement Based Care in Mental Health Shared Decision-Making [ November 2018 Prepared for: Department of Veterans Affairs Veterans Health Administration Quality Enhancement Research Initiative Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence-based Synthesis Program (ESP) Coordinating Center Portland VA Health Care System Portland, OR Mark Helfand, MD, MPH, MS, Director Department of Veterans (...) Affairs Health Services Research & Development Service Evidence Brief: Use of Patient Reported Outcome Measures for Measurement Based Care in Mental Health Shared Decision-Making Investigators: Kim Peterson, MS Johanna Anderson, MPH Donald Bourne, MPH Evidence-based Synthesis Program 4 Evidence Brief: Use of PROMs for MBC in Shared Decision-Making Evidence-based Synthesis Program i PREFACE The VA Evidence-based Synthesis Program (ESP) was established in 2007 to provide timely and accurate syntheses

2018 Veterans Affairs Evidence-based Synthesis Program Reports

10. Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks (PubMed)

Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks Dementia and other chronic conditions can compromise a person's ability to make independent personal and financial decisions. In the wake of an ageing population and rising incidence of chronic conditions, the number of persons who may require Decision-Making Capacity Assessments (DMCAs (...) ) is likely to increase. Legislation (e.g., Trusteeship, Guardianship, Medical Assistance in Dying) also necessitates that DMCAs adhere to legislative requirements and principles. An intentional, explicit and systematic means of implementing standardized DMCA best-practices is advisable. This single exploratory case-study examined the perspectives of senior leaders and clinical experts regarding the utility of using the National Implementation Research Network (NIRN) Model to facilitate implementation

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2018 BMC research notes

11. Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients' capacity for decision-making. (PubMed)

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients' capacity for decision-making. A relational approach to autonomy refers to the way in which social conditions and relationships shape a person's self-identity and capacity in decision-making. This article provides an empirical account of how treatment choices for women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, family (...) of patients influenced the rationale for treatment decision-making. Patients drew on supportive resources from family and medical advice from clinicians to progress with treatment goals. While clinicians held much social power over patients as the medical experts, patients highlighted the need for clinicians to earn their trust through demonstrated professionalism. Information exchange created a communicative space for clinicians and patients to negotiate shared values, promoting greater patient ownership

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2018 BMC health services research

12. Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA). (PubMed)

Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA). The Cancer of the Prostate Risk Assessment (CAPRA) score was designed and validated several times to predict the biochemical recurrence-free survival after a radical prostatectomy. Our objectives were, first, to study the clinical validity of the CAPRA score, and, second, to assess its clinical utility (...) for stratified medicine from an original patient-centered approach.We proposed a meta-analysis based on a literature search using MEDLINE. Observed and predicted biochemical-recurrence-free survivals were compared to assess the calibration of the CAPRA score. Discriminative capacities were evaluated by estimating the summary time-dependent ROC curve. The clinical utility of the CAPRA score was evaluated according to the following stratified decisions: active monitoring for low-risk patients, prostatectomy

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2019 Medical Informatics and Decision Making

13. Protocol for the Assessment of Patient Capacity to Make End-of-Life Treatment Decisions. (PubMed)

. General decision-making capacity has been well studied, but few clear protocols exist for ascertaining capacity at the end of life. Without clear guidelines about how to assess capacity, medical staff may ignore assessment and operate from invalid assumptions. In the interests of protecting patients' agency, we propose a straightforward protocol for assessing capacity to make decisions about end-of-life interventions.Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine (...) Protocol for the Assessment of Patient Capacity to Make End-of-Life Treatment Decisions. Patients' right to decide what happens to their bodies, especially around the end of life, is enshrined in legislation across the world, but questions often arise about whether a patient is capable of meaningfully participating in such decisions. Because of uncertainties about capacity, care providers and administrative agencies often must decide whether to honor, or even to elicit, patients' wishes

2017 Journal of the American Medical Directors Association

14. How the "Understanding Research Evidence" Web-Based Video Series From the National Collaborating Centre for Methods and Tools Contributes to Public Health Capacity to Practice Evidence-Informed Decision Making: Mixed-Methods Evaluation. (PubMed)

How the "Understanding Research Evidence" Web-Based Video Series From the National Collaborating Centre for Methods and Tools Contributes to Public Health Capacity to Practice Evidence-Informed Decision Making: Mixed-Methods Evaluation. The National Collaborating Centre for Methods and Tools (NCCMT) offers workshops and webinars to build public health capacity for evidence-informed decision-making. Despite positive feedback for NCCMT workshops and resources, NCCMT users found key terms used (...) of the evaluation showed that watching the videos resulted in an increase in knowledge, and participants had an overall positive experience with the URE videos. With increased competence in using the best available evidence, professionals are empowered to contribute to decisions that can improve health outcomes of communities.©Linda Chan, Jeannie Mackintosh, Maureen Dobbins. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.09.2017.

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2017 Journal of medical Internet research

15. Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer. (PubMed)

Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer. Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision (...) -making capacity and its assessment in terminally ill cancer patients.Fifty-five patients with advanced cancer receiving inpatient palliative care and 50 healthy adults were administered the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. Participants made a hypothetical treatment decision about whether to accept artificial nutrition

2017 The American Journal of Geriatric Psychiatry

16. Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases (PubMed)

than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients' ability to consent to future medical treatment (...) Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional

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2017 Brain sciences

17. Cumulative mild partial sleep deprivation negatively impacts working memory capacity but not sustained attention, response inhibition, or decision making: a randomized controlled trial. (PubMed)

. The participants consisted of 93 adults (mean age 24.3 years, SD 4.7; 46 men, 47 women) with no reported sleep problem, behavioral issue, or medical issue.Performance on the working memory capacity task improved between the baseline and experimental sessions for the placebo group but not the sleep-restriction group. Performance on tasks measuring sustained attention, response inhibition, and decision making did not change under either experimental condition.Cumulative partial sleep deprivation negatively (...) Cumulative mild partial sleep deprivation negatively impacts working memory capacity but not sustained attention, response inhibition, or decision making: a randomized controlled trial. Twenty-eight per cent (28%) of adults sleep at least 1 hour less than they consider optimal, yet the effects of such cumulative mild partial sleep deprivation on cognitive functions are unknown. The objective of this study was to examine how cumulative mild partial sleep deprivation over 6 nights can impact

2019 Sleep health

18. Hospital Formularies Decision-Making Process

Hospital Formularies Decision-Making Process Hospital Formularies Decision-Making Process | CADTH.ca Find the information you need Hospital Formularies Decision-Making Process Hospital Formularies Decision-Making Process Published on: March 16, 2015 Project Number: ES0290 Product Line: Issue: 47 Result type: Report Context In Canada, hospital-based Pharmacy and Therapeutics Committees may function at an individual hospital level, district or regional health authority level, or provincial level (...) assurance representatives and members of the public. 1 Formulary decisions are made on the basis of empirical evidence; however, factors such as safety of similar available agents, direct costs, cost offsets, and the total cost of care with a new drug compared with current care may also significantly impact formulary decisions. 2 CADTH provides recommendations to the federal, provincial, and territorial public drug plans (hereafter the "public drug plans") to support their formulary decision-making

2016 Canadian Agency for Drugs and Technologies in Health - Environmental Scanning

19. Preparing Patients and Family Caregivers for Medical Decision Making

Preparing Patients and Family Caregivers for Medical Decision Making Preparing Patients and Family Caregivers for Medical Decision Making - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Preparing Patients (...) and Family Caregivers for Medical Decision Making The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03037346 Recruitment Status : Recruiting First Posted : January 31, 2017 Last Update Posted : September 6, 2018 See Sponsor: M.D

2017 Clinical Trials

20. Medical decision-making in children and adolescents: developmental and neuroscientific aspects. (PubMed)

to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills (...) for decision-making, may need support of facilitating environmental factors.This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make

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2017 BMC Pediatrics

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