GERI Elder Informed Consent Flashcards
(34 cards)
What are the 3 criteria for informed consent?
- VOLUNTARY and FREE OF COERCION. 2. Pt must be given adequate information (in language they understand) to make a decision. 3. Pt must have CAPACITY.
What is competency?
The capacity to understand the consequences of one’s decisions
If a patient lacks competency, what must happen?
They must establish a power of attorney or guardianship.
Who can determine if a pt has capacity or not?
A physician
Are health providers identifying patients with a lack of decision-making capacity?
No, not well. Only identifying 1 in 4 patients. Fail to identify 30-50% of patients who lack decision making capacity.
What are the 4 standards that one must meet in order to have full decision making capacity?
- Ability to communicate a choice 2. Understand the relevant information 3. Appreciate the medical consequences of the situation. 4. Reason for treatment choices.
What is a good way to ensure a patient understands the relevant information of their medical plan?
Ask the patient to tell you in their own words what you told them about. —> Have them repeat the problem with their health, the recommended treatment, possible risks and benefits, alternative treatments, and risks/benefits of no treatment.
What must you always discuss with a patient when starting them on a new medication or recommending a new procedure?
The RISKS and BENEFITS.
What are the 6 indications for formal capacity assessment?
- Change in mental status 2. Pt refuses standard of care 3. Patient consents quickly to invasive or risky treatment. 4. Pt refuses treatment but does not say why. 5. Refusal of treatment seems irrational. 6. Pt reverses choice without reasoning.
Is a lack of capacity more commonly seen in men or women?
Men!
What are the common causes of lack of capacity in men?
Neurologic issues or substance use.
What are the the common causes of lack of capacity in women?
- Endocrine disorder 2. Mood disorder 3. Psychiatric illness
Are men or women more likely to leave against medical advice?
Men!
What are the 4 risk factors for impaired decision making?
- Altered mental status 2. Extreme age 3. Fear or discomfort in health-care setting 4. Multiple sensory limitations (i.e. vision and hearing).
Do patients with moderate dementia have decisional capacity?
YES, usually.
Do patients with severe dementia have decisional capacity?
By definition they do NOT.
Do most patients with Parkinson’s disease have decisional capacity?
YES. Usually little to no cognitive impairment until Parkinson’s dementia progresses.
If a patient has low health literacy, are they able to have decisional capacity? If so, what consequences can this cause?
YES. But this can lead to higher uncertainty in health decisions and decisional regret.
Are those with mental retardation able to make medical decisions?
50% mild retardation-yes, 18% moderate retardation-no.
What is necessary when making medical decisions for a patient with mental retardation?
A patient-centered team approach, involving the patient and a power of attorney early on.
Are patients with psychiatric disorders able to make medical decisions?
It depends! - 50% of hospitalized patients with schizophrenia or symptomatic bipolar disorder have impaired capacity. - 25% of hospitalized patients with depression have impaired capacity.
How do you assess one’s capacity?
- Directed clinical interview 2. Formal assessment tools 3. History from family 4. Physical assessment 5. Laboratory testing and neuroimaging studies 6. Mental status examination
What is the gold standard assessment tool for capacity?
MacArthur Competence Assessment Tool - Takes 20-30 mins - Used by psychologists and psychiatrists - Useful for routine cases
The Mini-Mental Status Examination (MMSE) can be used to assess capacity. What score is suggestive of this?
<21.
