Improving Knowledge and Confidence in Assessing Decision-Making Capacity in Persons with Aphasia

Research Objectives: To assess the efficacy of a novel, interactive, interdisciplinary education module that provides training in evaluating decision-making capacity (DMC) in persons with aphasia.

Design: Pre-post treatment design.

Setting: An urban rehabilitation hospital.

Participants: 28 speech-language pathologists (SLP) and 7 DMC evaluators (psychologists and care managers) with various levels of experience.

Interventions: Training in DMC concepts and supported communication strategies via an interactive online 75-minute education module. The module included demonstration videos of the DMC evaluator, the SLP, and individuals with aphasia, that captured realistic communication challenges during scenarios modeled after real-life cases.

Main Outcome Measures: Change from pre-training to post-training in (1) knowledge of DMC and supported communication strategies, and (2) confidence with key concepts related to DMC evaluation and supported communication.

Results: Prior to training, 29/35 (83%) trainees indicated having no or limited knowledge, or being somewhat knowledgeable about the components contributing to DMC. Post-training, 33/35 (94%) trainees selected ratings of good to very knowledgeable. Pre-training, 4/35 (11%) trainees indicated having no or limited knowledge of supported communication strategies for DMC evaluations, and 4/35 (11%) rated themselves as somewhat knowledgeable. Post-training, 33/35 (94%) trainees selected ratings of good to very knowledgeable. Pre-training, 17/35 (49%) indicated having no or limited confidence in collaborating in DMC evaluations for individuals with aphasia, with 8/35 (23%) indicating they were somewhat confident. Post-training, 34/35 (97%) trainees selected good to very confident.

Conclusions: Decision-making capacity, the ability of a patient to make autonomous decisions, is typically evaluated in health care settings using a semi-structured interview approach. The presence of aphasia presents a significant challenge to DMC assessments, yet can be ameliorated by supports from a skilled speech-language pathologist. Results demonstrate that training promotes confidence in cross-disciplinary collaborations. Interdisciplinary training may promote engagement in DMC evaluations and provide opportunities for autonomous decision-making and equitable access for patients with communication impairments.

Author(s) Disclosures: The authors have no conflicts of interest to report.