Developing a Decision-Making Capacity Assessment Clinical Pathway for Use in Primary Care: a Qualitative Exploratory Case Study

• Published in: Canadian geriatrics journal CGJ Vol. 24; no. 1; pp. 26 - 35
• Main Authors: Charles, Lesley, Torti, Jacqueline Mi, Brémault-Phillips, Suzette, Dobbs, Bonnie, Tian, Peter Gj, Khera, Sheny, Abbasi, Marjan, Chan, Karenn, Carr, Frances, Parmar, Jasneet
• Format: Journal Article
• Language: English
• Published: Canada Canadian Geriatrics Society 01.03.2021
• Subjects: Original Research; clinical pathway; primary care; decision-making capacity assessment
• ISSN: 1925-8348; 1925-8348
• DOI: 10.5770/cgj.24.400

With an ageing population, the incidence of dementia will increase, as will the number of persons requiring decision-making capacity assessments. For over 10 years, we have trained family physicians in conducting decision-making capacity assessments. Physician feedback post-training, however, has highlighted the need to integrate the decision-making capacity assessment process into the primary care context. The purpose of this study was to develop a decision-making capacity assessment clinical pathway for implementation in primary care. A qualitative exploratory case-study design was used to obtain participants' perspectives regarding the utility of a visual algorithm detailing a decision-making capacity assessment clinical pathway for use in primary care. Three focus groups were conducted with family physicians (n=4) and allied health professionals (n=6) in two primary care clinics in Alberta. A revised algorithm was developed based on their feedback. In the focus groups, participants identified inconsistencies and a lack of standardization regarding decision-making capacity assessments within primary care, and provided feedback regarding a decision-making capacity assessment clinical pathway to make it more applicable to primary care. Participants described this pathway as appealing and straightforward; they also made suggestions to make it more primary care-centric. Participants indicated that the presented pathway would improve teamwork and standardization of decision-making capacity assessments within primary care. Use of a decision-making capacity assessment clinical pathway has the potential to standardize decision-making capacity assessment processes in primary care, and support least intrusive and least restrictive patient outcomes for community-dwelling older adults.