Decision-making capacity and aphasia: speech-language pathologists' perspectives

Background: In health care settings, a person's ability to make decisions may be questioned as a result of neurological disease or injury that can affect cognitive function. To determine whether a person is able to make a decision, health care professionals are required to carry out an assessment of decision-making capacity (DMC; also known as capacity assessments). For individuals with aphasia, these types of assessment may be problematic because they rely heavily on language abilities. There is a growing body of literature available on capacity assessments of individuals with aphasia, yet there are few studies on the perspectives of speech-language pathologists (SLPs) related to DMC assessments of individuals with aphasia, including barriers and facilitators to valid assessments.Aims: The purpose of this study was to explore perspectives of SLPs on assessments of DMC with individuals with aphasia. The following research questions were of interest: (1) What do SLPs know about capacity assessment? (2) What are the perspectives of SLPs regarding the current state of capacity assessment of individuals with aphasia? (3) What recommendations do SLPs have regarding the assessment of DMC of persons with aphasia (PWA)?Methods and Procedures: In the context of a qualitative research paradigm, researchers carried out semi-structured interviews with 15 SLPs in Alberta, Canada. An interpretive description design was used for data analysis and interpretation.Outcomes and Results: Participants discussed three major topics: (1) knowledge of capacity of assessments; (2) assessments of DMC and PWA; and (3) involvement of SLPs in capacity assessments. Participants had very general knowledge of capacity assessments. Participants reported that they thought that PWA were at a disadvantage during capacity assessments. Participants recognised that SLPs have professional skills that enable them to enhance assessment of DMC in PWA. The results of this study confirm and extend findings from other international research studies.Conclusions: SLPs should be involved in capacity assessments for PWA. Their knowledge in the areas of communication and cognition are important to facilitate fair, valid capacity assessments. The findings of this study may be used to inform recommendations for SLPs to assume different roles in the capacity assessment process.