Assessing patients decision-making capacity in the hospital setting: A literature review
Abstract
OBJECTIVE: Decision-making capacity assessments for hospital settings are challenging as it is dominated by the ethical and legal principles of maintaining autonomy and protection. Health clinicians, especially in rural areas, are challenged with a lack of a standardised processes and pathways for decision-making capacity assessment. A literature review was conducted to determine what measurement tools clinicians are utilising in the hospital setting for decision-making capacity assessment and how decisions relating to consent to treatment, independent living and finances are made. DESIGN: Literature review. METHOD: A search of MEDLINE, EMBASE and PsycINFO databases from January 2006 to April 2019 was conducted for peer-reviewed articles to determine how decision-making capacity assessments are conducted and the tools clinicians are utilising in the hospital setting. RESULTS: Five main themes were identified from this review: (a) domains of capacity; (b) capacity assessment; (c) capacity assessment instruments; (d) who performs capacity assessment; and (e) challenges and limitations to capacity assessment in the hospital setting. Currently, there is no gold standard for capacity assessment. CONCLUSION: This review shows that there is currently a lack of a uniform approach or a singular test to determine capacity. It is proposed that a multidisciplinary approach to decision-making capacity assessment could be an effective model in the hospital setting, especially in rural health due to limited access to aged care specialists. It is important that clinicians receive ongoing training in decision-making capacity assessment and further research is recommended in this specialised area of practice.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The diversity of capacity measurement instruments hampers the ability to draw clear conclusions from prior work.
“The different cognitive and clinical variables influencing this construct (Cáceda et al., 2014;Larkin & Hutton, 2017), and the diversity of capacity measurement instruments (John et al., 2020), hamper our ability to draw clear conclusions from this work.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as John et al., 2020
Cites
Does This Patient Have Medical Decision-Making Capacity?
Sessums, L. L., Zembrzuska, H. D., & Jackson, J. L. (2011) · JAMA · doi:10.1001/jama.2011.1023 · Cited by 338 · see citing works
Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research
Moye, J. A., & Marson, D. C. (2007) · The Journals of Gerontology Series B · doi:10.1093/geronb/62.1.p3 · Cited by 332 · see citing works
Assessment of capacity in an aging society.
Moye, J. A., Marson, D. C., & Edelstein, B. A. (2013) · American Psychologist · doi:10.1037/a0032159 · Cited by 143 · see citing works
Economic cost of dementia in Australia 2016-2056
Brown, L., Hansnata, E., & La, H. A. (2017) · Cited by 114 · see citing works
Systematic review on the prevalence of lack of capacity in medical and psychiatric settings
Lepping, P., Stanly, T., & Turner, J. (2015) · Clinical Medicine · doi:10.7861/clinmedicine.15-4-337 · Cited by 110 · see citing works
Neuropsychological predictors of decision-making capacity over 9 months in mild-to-moderate dementia
Moye, J. A., Karel, M. J., Gurrera, R. J., & Azar, A. R. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.00288.x · Cited by 102 · see citing works
Lichtenberg, P. A., Stoltman, J. J. K., Ficker, L. J., Iris, M. A., & Mast, B. T. (2014) · Clinical Gerontologist · doi:10.1080/07317115.2014.970318 · Cited by 101 · see citing works
Cognitive performance predicts treatment decisional abilities in mild to moderate dementia
Gurrera, R. J., Moye, J. A., Karel, M. J., Azar, A. R., & Armesto, J. C. (2006) · Neurology · doi:10.1212/01.wnl.0000210527.13661.d1 · Cited by 100 · see citing works
Dementia, Decision Making, and Capacity
Darby, R. R., & Dickerson, B. C. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000163 · Cited by 85 · see citing works
Assessment of Financial Competence
Kershaw, M. M., & Webber, L. S. (2008) · Psychiatry Psychology and Law · doi:10.1080/13218710701873965 · Cited by 67 · see citing works
Assessment of Decision-Making Capacity: Views and Experiences of Consultation Psychiatrists
Seyfried, L. S., Ryan, K. A., & Kim, S. Y. H. (2012) · Psychosomatics · doi:10.1016/j.psym.2012.08.001 · Cited by 60 · see citing works
Mayo, A. M., & Wallhagen, M. I. (2009) · Research in Gerontological Nursing · doi:10.3928/19404921-20090401-08 · Cited by 55 · see citing works
Moberg, P. J., & Rick, J. H. (2008) · Neurorehabilitation · doi:10.3233/nre-2008-23504 · Cited by 50 · see citing works
Mental incapacity in patients undergoing neuro-oncologic treatment
Kerrigan, S., Erridge, S., Liaquat, I., Graham, C., & Grant, R. (2014) · Neurology · doi:10.1212/wnl.0000000000000671 · Cited by 50 · see citing works
Who Can Decide? The six step capacity assessment process
Darzins, P. J., Molloy, W., & Strang, D. (2000) · Cited by 44 · see citing works
Skelton, F., Kunik, M. E., Regev, T., & Naik, A. D. (2009) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2009.04.016 · Cited by 41 · see citing works
Naik, A. D., Teal, C. R., Pavlik, V., Dyer, C. B., & McCullough, L. B. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01979.x · Cited by 33 · see citing works
Lui, V. W.-C., LAM, L. C. W., Chau, R. C. M., Fung, A. W. T., Wong, B. M. L., Leung, G. T. Y., Leung, K. F., Chiu, H. F. K., Karlawish, J. H., & Appelbaum, P. S. (2013) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988713481268 · Cited by 30 · see citing works
Gambina, G., Bonazzi, A., Valbusa, V., Condoleo, M. T., Bortolami, O., Broggio, E., Sala, F., Moretto, G., & Moro, V. (2013) · Neurological Sciences · doi:10.1007/s10072-013-1523-5 · Cited by 28 · see citing works
Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research
Moye, J. A., & Marson, D. C. (2009) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.7.1.foc88 · Cited by 28 · see citing works
What do doctors know about assessing decision-making capacity?
Young, G., Douglass, A., & Davison, L. (2018) · PubMed · Cited by 27 · see citing works
Assessment of decision-making capacity: Exploration of common practices among neuropsychologists
Mullaly, E., Kinsella, G., Berberovic, N., et al. (2007) · Australian Psychologist · doi:10.1080/00050060601187142 · Cited by 25 · see citing works
Kahn, D. R., Bourgeois, J. A., Klein, S. C., & Iosif, A.-M. (2009) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.39.4.e · Cited by 21 · see citing works
Mental incapacity in hospitalised patients undergoing percutaneous endoscopic gastrostomy insertion
Rahman, M., Evans, K., Arif, N., & Gorard, S. A. C. (2011) · Clinical Nutrition · doi:10.1016/j.clnu.2011.10.002 · Cited by 20 · see citing works
Can this patient go home? Assessment of decision‐making capacity
Darzins, P. J. (2010) · Australian Occupational Therapy Journal · doi:10.1111/j.1440-1630.2010.00854.x · Cited by 18 · see citing works
Murphy, R., Fleming, S. M., Curley, A., Duffy, R. M., & Kelly, B. D. (2018) · QJM · doi:10.1093/qjmed/hcy219 · Cited by 17 · see citing works
Ethical and medico-legal implications of capacity of patients in geriatric surgery
Terranova, C., Cardin, F., Pietra, L. D., Zen, M., Bruttocao, A., & Militello, C. (2013) · Medicine Science and the Law · doi:10.1177/0025802412473963 · Cited by 16 · see citing works
Advanced age and decisional capacity: The effect of age on the ability to make health care decisions
Boettger, S., Bergman, M., Jenewein, J., & Boettger, S. (2016) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2016.06.011 · Cited by 13 · see citing works
Moye, J. A., Marson, D. C., Edelstein, B. A., Wood, S. A., & Saldivar, A. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-380882-0.00024-3 · Cited by 13 · see citing works
Carabellese, F., Felthous, A. R., Tegola, D. L., Piazzolla, G., Distaso, S., Logroscino, G., Leo, A., Ventriglio, A., & Catanesi, R. (2017) · International Journal of Social Psychiatry · doi:10.1177/0020764017739642 · Cited by 12 · see citing works
Peisah, C. (2017) · Mental health and illness worldwide · doi:10.1007/978-981-10-2414-6_17 · Cited by 11 · see citing works
A therapeutic approach to assessing legal capacity in Australia
Purser, K., Magner, E. S., & Madison, J. (2015) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2015.01.003 · Cited by 10 · see citing works
Swimming against the Tide: A Case Study on the Removal of Conservatorship and Guardianship
Page, K. S., & Hinrichs, K. L. M. (2016) · Clinical Gerontologist · doi:10.1080/07317115.2016.1177767 · Cited by 8 · see citing works
Chan, C. Y., Yong, S., Mhaisalkar, A. S., et al. (2018) · East Asian Archives of Psychiatry · doi:10.12809/eaap1752 · Cited by 8 · see citing works
Decisional Capacity Assessments and Advance Directives
Parthasarathi, U., & Ambrosini, D. L. (2016) · Springer eBooks · doi:10.1007/978-3-319-30346-8_6 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Marcó-García, S., Ariyo, K., Owen, G. S., & David, A. S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000242 · Cited by 18 · see citing works
- Authors
- John, S., Rowley, J., & Bartlett, K.
- Affiliations
- Government of New South Wales (AU)
- Coffs Harbour Health Campus Coffs Harbour NSW Australia
- Corresponding author
- John, Shibu
- Venue
- Australian Journal of Rural Health
- Publisher
- Wiley
- Published
- 2020-01-20
- Volume
- 28
- Issue
- 2
- Pages
- 141-148
- ISSN
- 1038-5282 (ISSN-L)
- 1440-1584
- OpenAlex
- W3003097692
- Cited by
- 28
- References
- 35
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 7 · 2020: 1
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian Journal of Rural Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Education and Training Institute
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- decision-making capacity, capacity assessment, hospital settings, informed consent, financial decision-making, multidisciplinary assessment, rural health, clinician training, elderly care
- MeSH terms
- Aged, Aged, 80 and over, Aging, Decision Making, Hospitals, Humans, Geriatric Assessment, Mental Competency, Needs Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
