DOI: 10.6084/m9.figshare.31346193
title: Accessible decision-making capacity evaluations for patients with aphasia: a quality improvement project to develop, implement, and evaluate an online training module for interdisciplinary healthcare providers

description: Decision-making capacity (DMC) is the ability to make informed, autonomous choices. In healthcare settings, a range of providers typically evaluate DMC using a semi-structured interview approach. The presence of aphasia introduces a significant challenge to DMC assessments because a patient’s communication challenges can mask their underlying capacity. This quality improvement project aimed to (1) train providers to integrate evidence-based communication accommodations with support from a speech-language pathologist (SLP) to reduce the risk of underestimating capacity during a DMC assessment; and (2) assess the effectiveness of the training intervention. A team of SLPs and bioethicists in a research and rehabilitation hospital developed and evaluated an online training module for DMC assessors and SLPs to support the delivery of accessible DMC evaluations for patients with aphasia. Trainees completed pre- and post-training surveys to indicate self-reported change in knowledge and confidence and provide feedback on their learning experience. The training resulted in positive learning experiences and statistically significant increases in self-reported knowledge and confidence for DMC evaluators and SLPs in providing accessible DMC evaluations for individuals with aphasia. The online training module was viewed as effective in promoting communication accessible DMC evaluations by interdisciplinary provider trainees. When decision-making capacity (DMC) evaluations are completed with patients with communication disabilities like aphasia, communication difficulties may mask a patient’s underlying capacity.If a patient’s capacity is masked and thereby underestimated in the course of a DMC evaluation, their rights within the healthcare context may be unfairly compromised.Integration of supportive communication principles and strategies during the course of a DMC evaluation by a skilled communication partner in collaboration with a DMC assessor can facilitate accurate information exchange and ameliorate the risk of underestimating the capacity of a patient with aphasia.Interdisciplinary online training can improve provider knowledge and confidence regarding key components of co-facilitated accessible DMC evaluations for persons with aphasia. When decision-making capacity (DMC) evaluations are completed with patients with communication disabilities like aphasia, communication difficulties may mask a patient’s underlying capacity. If a patient’s capacity is masked and thereby underestimated in the course of a DMC evaluation, their rights within the healthcare context may be unfairly compromised. Integration of supportive communication principles and strategies during the course of a DMC evaluation by a skilled communication partner in collaboration with a DMC assessor can facilitate accurate information exchange and ameliorate the risk of underestimating the capacity of a patient with aphasia. Interdisciplinary online training can improve provider knowledge and confidence regarding key components of co-facilitated accessible DMC evaluations for persons with aphasia.