Background Only mentally capable persons can complete advance directives (ADs). When persons without ADs are hospitalised and are thought to have questionable capacity, care providers may not trust the ability of those patients to make their own treatment decisions. Such situations can frustrate treatment decision-making and cause moral distressing situations. Some hospitalised patients with questionable capacity, however, may be able to participate in some basic advance care planning (ACP). This is because the skills necessary to do ACP vary based the preferences being discussed and the level of cognitive functioning needed to make certain decisions. As Appelbaum (2007) notes there are no formal practice guidelines for assessing a person’s capacity, and may require an interprofessional approach. Since patients should be permitted to participate with decision-making to the extent possible, hospitalised patients with questionable capacity should not automatically be disqualified from doing basic ACP in hospital settings.
Aim This presentation identifies and describes a viable approach that clinicians can use in hospital settings to help assess patients with questionable capacity, thereby providing a way for patients to do basic ACP in hospital settings while engaging in treatment decision-making to the greatest extent possible.
Methods A process that utilises interprofessional collaboration will be detailed toward assessing the mental functioning of hospitalised patients with questionable capacity. Several cases using this method will be discussed.
Conclusion Assisting hospitalised patients with questionable capacity do ACP is complicated. Developing a systematic approach toward capacity assessment helps distinguish when patients should and should not perform basic ACP in hospital settings.
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