Search

Objectives Depression can impair decision-making capacity (DMC) for health care decisions. However, it is unclear whether DMC improves after treatments for depression such as electroconvulsive therapy (ECT). There is limited evidence available on DMC for treatment in patients with depression referred for ECT, and it is unknown whether ECT has any impact on DMC. We hypothesized that ECT will improve DMC in severely depressed patients and that this change will be associated with reduced depressive symptom severity. Methods Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluated: Understanding, Appreciation, Reasoning, and Expressing a choice. This prospective study compared DMC abilities, depression severity, and cognition scores in 24 patients hospitalized with a major depressive episode before and 3 to 5 days after a course of ECT. Results Although Understanding scores significantly improved after ECT (P = 0.004, r = 0.41), there was no change in other abilities related to DMC or cognition scores. As expected, there was a large improvement in mood ratings after ECT, but the change in DMC abilities was not associated with change in depressive symptoms. Conclusions To our knowledge, this is the first study to provide data on the effects of ECT on DMC in patients with depression. Abilities related to DMC that may be affected in this group before treatment include Understanding and Reasoning. Findings indicate that DMC to consent to treatment mostly does not change after a course of ECT and some aspects can improve in patients with depression.

Introduction: Communication in dentistry is bilateral process which usually is based on response (understanding) by the person. That’s why the Oral Healthcare Providers (OHP) should be convinced the consent given by the patient is valid. It means that at the beginning of the treatment the orthodontist will ask a lot of questions and have expectations to receive appropriate answers. There is a specific lack of awareness about the first orthodontic consultation at 7y of age, occurrence and prevention of most of the common tooth jaw discrepancies which affect the oral health, self-confidence and overall development of the child. A variety of socio-demographic, educational, personal and other factors mostly divided into objective and subjective factors influences the perception of facial attractiveness. The orthodontic treatment lays down on the personal desire and attitudes, depends from the motivation but is not without a risk for the patient. The aim of the current research is to present the most objective and subjective factors identifying the patient’s refusal. Material and methods: It’s a case report based on preliminary discussion and orthodontic consultation over the cephalometric analysis and cast models. Orthodontic treatment protocol was followed and given informed consent by the individual was received. Results and discussions: An electronic search was conducted using the Medline database (PubMed), Science Direct, and Scopus. In this case report were described the treatment options for Class III malocclusion with an emphasis on maxillary protraction and existing impacted canine 13. The decision making capacity was evaluated and also what are the objective and subjective factors and how to proceed with patient refusal. Conclusions: Despite the orthodontist’s efforts to improve the management of the dental practice and to attract new patients, these challenges should never been from the first importance. Contemporary dentistry requires that the patient’s right to refuse should be respected and this refusal must be accepted. Because orthodontic treatment is expensive, the process of returning money or sharing responsibility for the treatment depend on the socio-cultural characteristics of both the patient and the doctor. The whole situation requires a very delicate approach, as it affects the image of the dental community in society at whole.

Decision-making Capacity (dmc) matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and concern for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy.

In Japan, the government’s recommendation for the HPV vaccine has been suspended for almost 8 years. A questionnaire survey was conducted in the Tsubaki Women’s Clinic, Matsuyama, Japan, to examine responses of the mothers of girls eligible for HPV vaccine before and after their doctor provided them an informative leaflet explaining the need for cervical cancer prevention. Among the 53 mothers who admitted to imposing some preconditions before being willing to encourage their daughters’ HPV vaccination, 21 (40%) mothers became more willing to vaccinate their daughters immediately after receiving the cervical cancer prevention linkage explanation provided by their doctor, and seven of the mothers (33%) even returned to the clinic to get their daughter vaccinated during our study period. Logistical regression analysis revealed that having initial preconditions required for their daughters’ HPV vaccination was an independent variable influencing the mothers’ change of willingness to get their daughters vaccinated immediately after receiving the explanation using the leaflet. We have found that to achieve maximum effectiveness, we can use an appropriate leaflet even under suspension of the governmental recommendation. Our future efforts should be focused on those mothers who are less likely to impose preconditions on their daughter’s vaccination.

OBJECTIVES: Lichtenberg et al. (2020a) reported on the implementation of a 10-item financial decision making screening scale (Financial Decision Tracker--FDT) in a state-wide Adult Protective Services (APS) project. This study examined which of the seven scored items reflecting the Appelbaum & Grisso decisional abilities model, were most sensitive to decision making deficits. METHODS: The Financial Decision Tracker was administered to 445 adults aged 60 years of older during APS investigations of financial exploitation. APS workers administered the FDT as part of their financial exploitation investigation. Overall seven scored FDT items were compared using T tests. RESULTS: Six of the seven risk-scored items were significantly different between those with and without decision making deficits. Two of the items had small effect sizes, and four items had moderate effect sizes. The larger, moderate effect sizes were related to risk to financial well-being (appreciation), impact on finances (understanding), and who benefits most from the decision (understanding). CONCLUSIONS: The main findings of the study supported the Appelbaum and Grisso’s decision-making model and the ability of specific items related to understanding and appreciation to differentiate between individuals with and without financial decision-making deficits. CLINICAL IMPLICATIONS: The FDT is a clinically reliable and validated tool for older adults.

Palliative care (PC) clinicians treat seriously ill patients who are at increased risk for compromised decision-making capacity (DMC). These patients face profound and complex questions about which treatments to accept and which to decline. PC clinicians, therefore, have the especially difficult task of performing thorough, fair, and accurate DMC assessments in the face of the complex effects of terminal illness, which may be complicated by fluctuating acute medical conditions, mental illness, or cognitive dysfunction. This study, written by a team of clinicians with expertise in PC, ethics, psychiatry, pediatrics, and geriatrics, aims to provide expert guidance to PC clinicians on best practice for complex DMC assessment.

This study examines to make up this significant gap in the existing literature. Using a cross-sectional sample consisting of 240 nurses in the hospitals of Uzbekistan and a structural model, with a random sampling technique by employing explanatory, and causal design was used to test the developed framework. Quantitative data was collected using questionnaires, the survey instruments were distributed by hand among the private and public sector, we find that nurses’ perceived safety culture (SC) and decision-making capacity (DMC) act as important mechanisms linking TL to PS. Meanwhile, nurses’ perceived locus of control (LC) moderates the effect of TL on SC and DMC in such a way that this effect is more salient for nurses with internal LC than for nurses with external LC. This paper examines the contribution, that individuals with high internal LC are more affected by TL, generate and can better develop SC and DMC. The study findings demonstrated the significant role of transformational leadership played in order to improve working conditions and the environment, which helps nurses to create good conditions, relationships with patients and increase patient safety. The theoretical and practical implications of this study are discussed

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms.

This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient's decision-making capacity. The study aims to answer: 1) does concern about a patient's treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST.

This study examines to make up this significant gap in the existing literature. Using a cross-sectional sample consisting of 240 nurses in the hospitals of Uzbekistan and a structural model, with a random sampling technique by employing explanatory, and causal design was used to test the developed framework. Quantitative data was collected using questionnaires, the survey instruments were distributed by hand among the private and public sector, we find that nurses’ perceived safety culture (SC) and decision-making capacity (DMC) act as important mechanisms linking TL to PS. Meanwhile, nurses’ perceived locus of control (LC) moderates the effect of TL on SC and DMC in such a way that this effect is more salient for nurses with internal LC than for nurses with external LC. This paper examines the contribution, that individuals with high internal LC are more affected by TL, generate and can better develop SC and DMC. The study findings demonstrated the significant role of transformational leadership played in order to improve working conditions and the environment, which helps nurses to create good conditions, relationships with patients and increase patient safety. The theoretical and practical implications of this study are discussed

Clinical situations in which psychiatrists are consulted to assess decision-making capacity often require complex management in addition to an opinion regarding decisional capacity. In these situations, the consultation-liaison psychiatrist's unique expertise may be useful in facilitating patient care. Some common contexts where this facilitation may be useful include the surrogate decision-making process, requests to leave against medical advice, and when considering nonconsensual interventions for incapacitated patients. In some instances, facilitation will be via psychotropic management and risk assessment. In other instances, skills may include supportive psychotherapy, empathic stakeholder engagement, mediation, and therapeutic-alliance building. [ Psychiatr Ann . 2021;51(3):106–111.]

This Conferencepaper seeks to answer a question resulting from literature, policy documents review and interviews carried out within the project: What are the most effective educational inclusion strategies for increasing participation and continuity in education among highly vulnerable displaced placed people currently living in the region of Sicily? The design of the selective-learning TAIS, i.e. the training opportunity “ALL you can LEARN”, proposes a participatory practice in education, shifting from an “induced” training offer approach (i.e. a dominating and top-down way to organise education for FDPs) to a “selective” approach aimed at developing a training offer in which several optional modules are offered so that participants can choose contents that are attractive for them. The ultimate aim is to increase learners’ decision-making capacity (in this specific case, Forcibly Displaced Women living and/or exposed to highly vulnerable situations and conditions, victims of human trafficking currently living in Sicily, originally from Ivory Coast, Nigeria, Sierra Leone, Somalia, Comoros and Tunisia) as they are to be intended as “co-experts” of the Responsible Research and Innovation (RRI) based inclusion strategy, thus having the opportunity to decide and co-design their learning experience according to a set of individual variables (interests and aspirations, level of studies and previously attended programmes, language knowledge, logistics and time availability, etc.).

BACKGROUND: Integrating bioethical concepts into preclinical medical school curriculum and engaging early medical learners in bioethics are a challenge. ACTIVITY: A total of 140 medical students participated in a 2-h simulation activity consisting of a series of standardized patient (SP) encounters. RESULTS: A total of 41 of 140 students (29%) completed the learner evaluation survey. Ninety-one percent thought that the SP encounter was relevant to their role as a future physician. Ninety-three percent of students rated the exercise as highly effective. CONCLUSIONS: SP encounters enhance preclinical medical students’ engagement with bioethics and provide learners practice applying these concepts to clinically relevant scenarios.

The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care.

The present study investigated decision-making in patients with Prader-Willi syndrome (PWS) using the Soochow Gambling Task (SGT). The objective was to assess whether adults with PWS have impaired ...

Walsh (2020) underscores how dementia leads to a cognitive transformative experience, which can result in a change in preferences, values, and beliefs. This transformation supports placing greater ...

Decision-making capacity (DMC) for pediatric patients can be difficult to determine and is influenced by a myriad of developmental considerations. This chapter begins with a discussion concerning the nature of decision-making and what constitutes competency. The “rule of sevens” framework is then used to explicate pertinent developmental milestones for children, dividing pediatric development into 0–7, 7–14, and 14+ years of age. In particular, the authors highlight the most important cognitive, social, and emotional considerations in each of these periods and how they pertain to a child’s ability to make important medical decisions.

Objectives: Because medical, midwifery and law students in Ghana constitute the next generation of health care and legal practitioners, this study aimed to evaluate their attitudes towards abortion and their perceptions of the decision-making capacity of pregnant adolescents. Methods: We conducted a cross-sectional survey among 340 medical, midwifery and law students. A pretested and validated questionnaire was used to collect relevant data on respondents’ sociodemographic characteristics, attitudes towards abortion and the perceived capacity and rationality of pregnant adolescents’ decisions. The χ2 test of independency and Fischer’s exact test were used where appropriate. Results: We retained 331 completed questionnaires for analysis. Respondents’ mean age was 21.0 ± 2.9 years and the majority (95.5%) were of the Christian faith. Women made up 77.9% (n = 258) of the sample. Most students (70.1%) were strongly in favour of abortion if it was for health reasons. More than three-quarters (78.0%) of the students strongly disagreed on the use of abortion for the purposes of sex selection. Most respondents (89.0%) were not in favour of legislation to make abortion available on request for pregnant adolescents, with medical students expressing a more negative attitude compared with law and midwifery students (p < 0.001). Over half of the midwifery students (52.6%) believed that adolescents should have full decision-making capacity regarding their pregnancy outcome, compared with law and medical students (p < 0.001). Conclusion: Tensions between adolescent reproductive autonomy, the accepted culture of third party involvement (parents and partners), and the current abortion law may require keen reflection if an improvement in access to safe abortion services is envisioned.

Objective: To assess the impact of a 2015 reform to the Mental Health Act 2007 (NSW) ( MHA) that was interpreted as requiring a reference to decision-making capacity (DMC) in reports to the NSW Mental Health Review Tribunal (MHRT). Method: A sample of reports to the MHRT were audited for references to the MHA’s treatment criteria and DMC in periods before and after the reforms, and the frequency of references between the two periods was compared. Results: The frequency of references to DMC did not change significantly after the reforms. (However, references to the ‘least restriction’ criterion increased markedly between the two periods). Conclusion: Despite legislative reforms and a supporting education campaign promoting the importance of consideration of DMC, references to DMC did not increase after the reforms.

Background: Clinicians at the bedside regularly encounter surprises or unexpected clinical developments that carry emotional, social, or moral overtones—especially when death is anticipated or when patients are particularly vulnerable. In such circumstances, clinicians may struggle to find practical clarity in making treatment plans that honor their fiduciary (literally, “entrusted”) duty to uphold equitably the ethical principles of beneficence, nonmaleficence, patient autonomy, and justice. Methods: We present the case of a patient who appeared to be actively dying and received an indwelling urinary catheter for the purpose of ensuring comfort. However, it led to an unintended reversal of renal failure and exacerbation of underlying psychiatric disease. This led to a meaningful change in the patient’s prognosis. It also created pragmatic challenges to shared decision making, which required an intentional interdisciplinary approach to balancing beneficence and patient autonomy. Conclusion: Palliative Care offers a holistic clinical approach to complex suffering. Palliative care specialists develop advanced skill sets in prognosis estimation, nuanced communication issues, and patient-centered goal setting. As this case highlights, prognosis can shift dramatically in the perimortem period, even with small changes in care plans. This case presented several biomedical, social-cultural, and ethical challenges to the team. Lessons from the case are presented regarding: the role a specialist palliative team might play throughout all stages of serious illness; approaching prognostication as an iterative rather than solitary task; and utilizing an ethical framework to care planning when there are barriers to shared decision making.

BACKGROUND In Germany, the drug law was revised in 2016 to include new regulations on clinical drug trials with adults who lack decision-making capacity. For the first time, trials with a merely indirect benefit (benefit for other patients with similar characteristics) will be possible if several safeguards are respected. The ethical justification and practicality of this regulation are controversially discussed. OBJECTIVES (1) Eliciting the current pertinent practice of research ethics committees in Germany regarding research with indirect benefit on adults without decision-making capacity; (2) exploring the possibilities and difficulties of implementing the new law. METHODS Semiquantitative, anonymous questionnaire among 249 members of all 53 human research ethics committees in Germany. RESULTS Eighty-four questionnaires were analyzed (response rate 34%). The participants disagreed on assigning research projects to the categories of research with direct benefit to the subject, with an indirect benefit, and without any benefit. Moreover, the criteria of minimum risk and minimum burden were interpreted heterogeneously. More than half of the participants judged the newly introduced research advance directive to be unnecessary, given the legal safeguards in place. The applicability of these directives was doubted because of the strict requirements for anticipatory informed consent and the restricted predictability of future research. CONCLUSION In spite of the new legal regulation, significant ethical uncertainties remain concerning research with indirect benefit on adults without decision-making capacity. It remains an open question whether we need a better explanation of the law, additional legal regulation, practice evaluation, or a completely new law.

Este artículo analiza la primera experiencia en España de compra pública pre-comercial aplicada a la transferencia del conocimiento. Las evidencias muestran que, más allá de los resultados obtenidos en términos de prototipos innovadores, este tipo de aplicación presenta unas características que potencialmente pueden generar cambios sustanciales en el sistema de innovación analizado. Particularmente de interés es el cambio de rol en el organismo público de investigación (CSIC), que pasa de tener funciones puramente de producción de I+D a tener capacidad de decisión en la asignación de fondos y monitorización del desarrollo de las innovaciones, transformando positivamente el ecosistema relacional. Los resultados obtenidos muestran una mayor eficacia de este instrumento respecto a otros más asentados en el tiempo.

Objective: Driving under the influence (DUI) of alcohol recidivism may be a risk-taking behavior motivated by a change in decision-making capacity. Decision-making capacity has been investigated by...

Objectives The number of hospital admissions related to suicide attempts is increasing. Involuntary treatment of psychiatric disorders has always been controversial, and this issue can be particularly sensitive in case of suicide behaviour. The aim of this study was to analyse variables associated with involuntary and voluntary legal status on admission of suicidal ideation and suicide attempt in real practice. Method The MacArthur Competency Assessment Tool for Treatment (MacCAT-T) was administered to a group of patients (n = 73) with suicide behaviour and different types of psychiatric admissions (voluntary and involuntary). Severity of depressive symptoms, suicidal ideation and intent, and insight level were also assessed. A discriminant analysis was used to determine the differences. Results MacCAT total score and insight level were the best variables to discriminate both groups. Although the majority of admissions were adequately classified according to their decision-making capacity, our results show some discrepancies at hospital admission. Conclusions Although this situation can be partly due to mistakes of interpretations of legal criteria for involuntary psychiatric admission or an inappropriate assessment of capacity to consent, due to the complexity of suicidal behaviour, a review of the classic criteria will also need to be considered, in order to ensure adequate support and to propose appropriate assessment tools for psychiatric and forensic practitioners.

Because autonomy is regarded as central to modern bioethics; there is a considerable focus on the criteria by which autonomy may be judged. The most significant criterion used in day-to-day practice is decision-making capacity. A person who is decision-making capacitous is regarded as autonomous ipso facto. This rarely considered background analysis places a great deal of weight on the notion of decision-making capacity and how this is assessed. A person who is deemed to lack autonomy will be treated differently to a person who is deemed to have autonomy, at least when it comes to some medical decisions. In this paper we consider how extending the standard approach to decision-making capacity may deliver a more authentic reflection of autonomy. We refer to this as the ‘authentic approach’, to highlight its difference. The ethical advantages of extending the standard approach authentically in hard medical cases is analysed using a case, with recommendations about application described.

The aim of the study was to determine the association between rural women’s decision-making power and the constraints faced by them while seeking Maternal and Child Health care services in northeastern Bangladesh. The study sample consisted of 150 mothers living in northeastern Bangladesh who had accessed institutional MCH care services during their pregnancy, childbirth and the postpartum period. Data were collected through a structured questionnaire using simple random sampling technique from January-April, 2018 and analyzed using descriptive statistics, decision making index and constraints facing indexing method through SPSS and Microsoft Excel. The study results showed that, decisions about treatment-seeking, consultation with the doctor during the prenatal and postnatal period, institutional birth preference and use/not use of contraceptives was always taken by the husband because the index was closer to the weighted value 200. But while making decisions about purchasing household daily needs, medicines, taking the first child or having more than two children, both husband and wife participated equally. On the other hands, constraint facing index showed that lack of medicine and vaccination, unhealthy environment and unprofessional behavior of the clinic’s people with CFI 651, 316 and 304 respectively, were the most commonly faced constraints by the rural women which discouraged them to seek institutional MCH care services. Though rural women were not completely suppressed in the northeastern region of Bangladesh, healthcare-seeking decisions were completely under the supervision of the men of families. Along with the socio-economic barriers, unprofessionalism, unavailability and mismanagement of the offered services also discouraged them to access institutional MCH care services. Awareness building among the rural people, especially in the recipients of this service along with Government and policy maker’s intervention to ensure a better quality of MCH care services can change the scenario of MCH care-seeking attitude of rural women in northeastern Bangladesh.

Background A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services’ and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare. Methods A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles. Results Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of ‘risk’ with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person. Conclusion The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives.

Background Increasing age and life expectancy, alongside the growing incidence of chronic conditions and dementia-related diseases, indicate more older individuals are likely to experience challenges regarding decision-making capacity. In Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statuary framework for adults who are experiencing difficulties with decision-making. This legislation has significant implications for all who work in health and social care, especially those working with older adults. An online survey was conducted to explore occupational therapy practices regarding decision-making capacity assessment and factors impacting on engagement in this area. Methods Occupational therapists in Ireland were invited to participate in a cross-sectional online questionnaire. Results One hundred and seventy-two occupational therapists responded. Most occupational therapists (65.77%, n=98) reported involvement in decision-making capacity assessments, particularly those working with older adults. Occupational therapists were more frequently requested to contribute to assessments of capacity regarding independent living (79.19%, n=118), driving (45.89%, n=67), and financial management (44.44%, n=64). Occupational therapists reported using a combination of approaches to inform decision-making capacity assessment, including interviews, observations and assessments of cognition and functional performance, and emphasised a strength-based approach. Many participants reported decision-making capacity assessment is more difficult than other aspects of practice and that they are not satisfied with decision-making capacity assessment procedures in their workplace. A large majority (91.86%, n=113) reported occupational therapists would benefit from additional training and practice resources for decision-making capacity assessment. Conclusion The study confirms that occupational therapists have a role to play in assessment of decision-making capacity assessment, particularly regarding independent living. However, the recommended approach to assessment should include all appropriate multidisciplinary team members. There is need for further education, resources and guidelines for occupational therapists and other healthcare professionals to better guide decision-making capacity assessment.

Background In a conference 2018, Senator Kelleher said she concurred with the statement describing ADMA “…. as a paradigm shift…a major, major culture shift which has yet to work through our societal systems….”(1) In 2016, a senior and manager speech and language therapist (SLT) won the Dementia Elevator Innovation Award with the project “Empowering Persons with Dementia to Become More Active Participants in Decision Making Related to Their Present and Future Needs”. The IASLT Position Statement on the role of the speech and language therapist (SLT) in assessing Capacity and Facilitating Understanding to Support Decision Making for Adults with Communication Disabilities 2017 names training others in assisted decision making as a key SLT role. Talking Mats (TM) (2) may help address some training issues outlined. TM is discussed in NICE-Capacity Guidelines 2018. The Phase 1 project outlined recommends progression to Phase 2. Methods In 2018, the senior SLT trained SLTs working professionally with people with dementia across different service settings. They made a prior commitment to attend and complete the course and to trial TM with people with dementia. Results The Phase 1 report Dec 18 contains 16 brief case studies. Some initial findings: Facilitates strengths rather than deficits.Helpful for assisted decision-making when listeners are trained.Pictures help maintain attention and aid comprehension.Pictorial record of photographed TM viewed very positively, particularly for meetings.Video recording sessions, with consent, greatly enhances reflective practice.It helped address the unmet needs of one person with dementia who presented with responsive behaviour. Conclusion Talking Mats was strongly endorsed by all participants. Recommendations in Phase 1 report 2018 included progressing to Phase 2 i.e. training the six SLTs to become TM trainers and commence cascading through the system. We are currently awaiting funding approval.

Having a child born prematurely can plunge parents into an unknown and sometimes frightening situation, where they experience a loss of control over events and reduced decision making capacity. Preterm birth sometimes results in post-traumatic stress disorder for parents and negatively impacts on parent-child interactional patterns, especially if parents were unprepared for this eventuality. The role of information, support and early intervention in parents’ coping capacity in this situation has been noted in developmental systems theory to contribute to family interactional patterns. This paper reports on a mixed-methods study that explored the information and support needed by and available to parents following pre-term birth in England and the effect of this on their emotional well-being. The findings suggest that support systems do not always provide timely or helpful emotional or practical support to parents and this has the potential to place additional stress on family interactional patterns, especially where parents were unprepared for the possibility of pre-term birth.

Under both No Child Left Behind and the Every Student Succeeds Act, school leaders have been mandated to employ data-driven decision-making (DDDM) to diagnose student needs, implement targeted supports, and design school improvements. However, district administrators tasked with developing principals’ DDDM capacity face a tough road. The authors present four lessons for doing so based on lessons learned from one urban district’s year-long data dashboard intervention for their 200+ principals.

Background Based on an actual case in which a psychiatrist was called in to assess a patient’s capacity to refuse treatment, the aim of this study is to discuss how to manage this ethical and clinical issue and the dilemmas faced by the medical team. Case presentation: The case involved a 45-year-old female patient diagnosed with breast cancer who refused treatment. Since the mastology team had doubts about the patient’s mental state and given that she refused to consent to surgery, a forensic psychiatric consult was requested. Conclusion The forensic psychiatry team concluded that the patient’s decision-making capacity was preserved. The team suggested some actions to help the specialists deal with the ethical conflict. A reflection is proposed about the role of psychiatrists when an ethical dilemma involving decision-making capacity emerges in clinical situations, elucidating their work not only as physicians who determine diagnoses and conducts, but also as agents of transformation in the doctor–patient relationship.