ABSTRACT

Background

The law is leading a cultural shift away from medical paternalism towards shared decision-making with patients. A person’s ability to make decisions about their care and treatment is regulated through mental capacity law in the UK. A verbal interview is used to judge a person’s capacity. People with aphasia (PwA) may retain the cognitive ability to make decisions but have difficulty understanding information and expressing their wishes. PwA are at risk of having their capacity status misidentified without the support of skilled communication partners such as Speech and Language Therapists (SLTs). Currently, little is known about the SLTs’ role in capacity assessment for PwA in the UK.

Aims

This research aimed to explore UK SLTs’ experience of mental capacity assessment in PwA, focusing on the principal challenges and facilitators and the role SLTs play in the assessment process and within the multidisciplinary team (MDT).

Methods

A qualitative approach was taken using semi-structured interviews to explore SLTs’ perspectives. 13 interviews were conducted with SLTs from England and Scotland. Data were analysed thematically.

Results

Participants reported that facilitators were routine decision types, patients without complex co-morbidities, availability of time, close collaborative teams where the role of the SLT was valued, and trust existed in the relationship with the PwA and their carers. Challenges to the process were infrequent decision types, patients with complex cognitive/communication impairments, lack of time, conflict with carers and the MDT, and lack of access to team support. SLTs inhabited a variety of roles in the process of mental capacity assessment. They were morally motivated to adopt supportive roles but were equivocal towards adopting assessor roles. Across the data set an ambiguous interpretation of terminology, processes and level of specialisation required emerged.

Conclusion

SLTs’ play a unique role in supporting PwA to exercise their right to autonomy. This study is the first to explore SLTs’ experience of mental capacity assessment across different UK jurisdictions. SLTs’ confidence in their role in capacity assessment is growing although the complexity of the process continues to present challenges. Broader training in legal and conceptual aspects of mental capacity would support a clearer understanding of assessment procedures and facilitate SLTs to promote their role more broadly with their colleagues.

中文翻译：

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失语症患者的心理能力评估：理解言语和语言治疗师的作用

摘要

背景

该法律正在引领文化转变，从医疗家长制转向与患者共同决策。一个人对他们的护理和治疗做出决定的能力是由英国的心智能力法规定的。口头面试是用来判断一个人的能力的。失语症 (PwA) 患者可能保留做出决定的认知能力，但难以理解信息和表达他们的愿望。如果没有言语和语言治疗师 (SLT) 等熟练沟通伙伴的支持，PwA 有可能被错误识别其能力状态。目前，对 SLT 在英国 PwA 能力评估中的作用知之甚少。

宗旨

本研究旨在探索英国 SLT 在 PwA 心智能力评估方面的经验，重点关注主要挑战和促进因素以及 SLT 在评估过程中和多学科团队 (MDT) 中发挥的作用。

方法

使用半结构化访谈采用定性方法来探索 SLT 的观点。对来自英格兰和苏格兰的 SLT 进行了 13 次采访。数据进行了专题分析。

结果

参与者报告说，协调员是常规决策类型，患者没有复杂的合并症，时间充足，密切协作的团队重视 SLT 的作用，并且在与 PwA 及其护理人员的关系中存在信任。该过程面临的挑战是不常见的决策类型、具有复杂认知/沟通障碍的患者、缺乏时间、与护理人员和 MDT 的冲突以及无法获得团队支持。SLT 在心智能力评估过程中扮演着多种角色。他们在道德上动机采取支持性角色，但对采用评估者角色模棱两可。在整个数据集中，出现了对术语、流程和所需专业化水平的模棱两可的解释。

结论

SLT 在支持 PwA 行使其自主权方面发挥着独特的作用。本研究首次探讨了 SLT 在英国不同司法管辖区进行心智能力评估的经验。尽管过程的复杂性继续带来挑战，但 SLT 对其在能力评估中的作用的信心正在增强。在心智能力的法律和概念方面进行更广泛的培训将有助于更清楚地了解评估程序，并有助于 SLT 更广泛地促进他们与同事的作用。