Decision-making capacity in aphasia: SLT’s contribution in England

Abstract

Background: Individuals’ right to be involved with decisions regarding their health and social care is the cornerstone for modern patient-centred care. Decision-making is a complex process that involves multiple cognitive and linguistic abilities. These are often challenging for people with aphasia (PWA). The Mental Capacity Act (MCA) Code of Practice (2007) recommends that speech and language therapists (SLTs) support capacity assessments for individuals with communication problems, such as PWA. To date, little is known regarding SLTs’ involvement in the UK for supporting decision-making and capacity assessment for PWA. Aims: This research provides data to document when, how, and the extent to which SLTs are being used in capacity assessment for PWA in England. We also determined SLTs’ training and resource needs in capacity assessments, and their role in inter-professional training. Methods & Procedures: 56 SLTs working with PWA from a wide range of clinical settings in England were recruited; they completed a secure questionnaire using the online survey tool Survey Monkey. The questionnaire collected information in the following areas: knowledge and awareness of the MCA; current involvement of SLTs in capacity assessments and decision-making; inter-professional understanding of SLTs roles in capacity assessments; and training needs of SLTs. Outcomes & Results: The SLTs who participated in this survey indicated that they were not regularly involved to support capacity assessment for PWA. Moreover, they also reported that other professionals on the care team did not fully recognise or utilise their skills in supporting capacity assessment for PWA. Moreover, SLTs were not solicited to train professionals regarding communication difficulties in aphasia and its impact on capacity assessments. SLTs wanted profession-specific training to fulfil the role of supporting PWA in capacity assessments more effectively and reliably. Conclusions: Healthcare professionals have an ethical duty to ensure that judgements of capacity are unbiased and accurate. SLTs have an important contribution to make but their skills and knowledge are not fully recognised or utilised. These findings highlight an important need to raise the profile of SLTs’ skills and expertise amongst professionals through education and/or inter-professional communications. This would enable SLTs to be regularly and effectively utilised in capacity assessments and decision-making for PWA.