An Evaluation of a Decision-Making Capacity Assessment Model Suzette Brémault-Phillips, PhD1; Jasneet Parmar, MBBS2; Steven Friesen, MEDes1; Laura Rogers, MScRS1; Ashley Pike, PhD1

1Department

of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta; 2Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Corresponding Author: Dr. Suzette Brémault-Phillips ([email protected])

Introduction

Results

Discussion

•  As life expectancy and chronicity of health conditions continue to rise, more individuals are likely to experience challenges regarding decision-making capacity (DMC). •  Domain-specific assessments (e.g. financial, personal affairs, accommodation) and interventions that employ the least intrusive and restrictive measures become increasingly necessary. •  To address this complex practice area, a DecisionMaking Capacity Assessment (DMCA) Model has been developed •  This Model includes: •  A best-practice process and associated tools •  An implementation strategy to facilitate integration of the best-practice process into practice by independent practitioners and inter-professional (IP) teams in various service sectors across the continuum of care. •  The purpose of this project was to conduct a developmental evaluation of the DMCA Model

•  Strengths of the DMCA Model included its: •  Best-practice process and implementation strategy •  Provision of specific tools/processes •  Focus on training/mentoring to enhance competencies •  Applicability to independent practitioners and interprofessional teams •  Participants agreed that they followed the DMCA Model’s guiding principles (90%), used problem-solving (92%), understood discipline-specific roles (87%), were confident in their knowledge of DMCAs (75%) and legislation (72%), accessed consultative services (88%), received management support (64%), and felt that use of the Model reduces conflicts regarding DMC issues (44%) •  Barriers to the DMCA Model: Implementation is impeded when role clarity, physician engagement, IP team buy-in, accountability, dedicated resources, information-sharing systems, & remuneration are lacking •  Facilitators of the DMCA Model: System-level supports, champions at every level and from each discipline, dedicated resources, job descriptions inclusive of DMCAs, ongoing education/mentoring supports, policies, processes and useful tools, knowledge of legislation, access to consultative services, and appropriate remuneration are required to support implementation

•  Overall, the DMCA Model was found to offer HCPs, IP teams, and organizations a holistic and adaptable bestpractice approach to DMCAs inclusive of tools and processes, and implementation strategies at the system and provider level that enable the integration of the bestpractice process into routine service provision •  The assessment process/tools and education/mentoring components of the DMCA Model enhance the ability of HCPs to more confidently, competently, and collaboratively work in this complex practice area to provide standardized DMCAs that result in least restrictive/intrusive outcomes for clients

Methods •  A mixed methods approach was used •  Key stakeholders and healthcare professionals (HCPs) utilizing the DMCA Model participated either in a day-long evaluation workshop that included focus groups (FGs) and a survey, or completed the survey only. •  Survey (n=126); FG (n=49)

The  Decision-­‐Making  Capacity  Assessment  (DMCA)  Model  

Conclusions •  The DMCA Model offers a best-practice and implementation strategy to DMCAs that aims to: •  Maximize client autonomy •  Enhance confidence among service providers and organizations to conduct DMCAs •  Offer least restrictive and intrusive solutions •  Facilitate IP and inter-agency collaboration •  Reduce potential legal costs through use of a standardized process •  Addressing barriers and further contextualizing the DMCA Model is warranted

Overview  of  the  DMCA  Model  Care  Map  –  3  Steps