JCPSLP Vol 23, Issue 1 2021

Table 1. Databases and search terms used to identify literature for review

Database

Search terms

Limits

Articles (n)

2009–2019; English, academic journals; full text.

40

Medline

“assessment” (MeSH) AND decision-making AND patient*

2009–2019; English; academic journals; full text

33

CINAHL

“assessment” (Subject heading) AND decision-making capacity AND patient* “assessment” AND “decision-making capacity” AND “patients” “assessment” AND “decision-making capacity” AND “patients”

2009–2019; English; academic journals; full text

212

Scopus

2009–2019; full text; English; academic journals

14

Psychinfo

Total records after database search Total records after duplicates removed

299 236

general hospital population and can be as high as 88% in specialised wards such as neurology (Hemsley et al., 2016). This does not account for patients with low health literacy or those whose primary language is different from the primary language of the health service. A study by McCrabb et al. (2019) found 66% of patients in acute care and 46% of patients in geriatric care and rehabilitation required assistance to communicate their health care needs. Many patients in hospitals need communication support, including those with limited language proficiency, speech, cognition, hearing or vision impairments, low health literacy, and temporary conditions such as intubation (Blackstone & Pressman, 2016). Communication failures are in the top three leading causes of sentinel events in hospitals, making good communication critical to safe health care (Bartlett et al., 2008). Communication impairment is prevalent in hospital and DMCAs are heavily language loaded. SLPs are uniquely skilled to support communication and thereby enhance DMCAs in hospital. As such, SLPs can play a role in improving communication for safety and quality of care. The role of the SLP in DMCA is not well documented. This scoping review aims to summarise the literature on current practice in the assessment of DMC in hospital settings and opportunities for improvement. This is intended to inform all practitioners, with a focus on SLPs, provide guidance on best practices, identify policy implications, and gaps in the literature for future research. Methods Study design A scoping review design was used to identify a variety of study outcomes and themes. The authors of this paper who had a range of backgrounds met for several sessions to determine the research question. It was determined a broad research question would yield more papers, enabling a more extensive understanding of DMCA practices. The role of the SLP was considered as part of this wider review The proposed broad research question for this review was: What is the most effective method(s) for assessing decision-making capacity of patients in hospital? Search strategy Four electronic databases including CINAHL, Medline, PsychInfo, and Scopus were searched during 2020 for

articles published between 2009 and 2020. As including SLP in the search terms limited the number of papers returned, a broader search was conducted. The following key search terms were selected and combined with Boolean operators: assessment AND decision-making capacity AND patient*. Limiters included peer review and published in English. Studies that focused on DMCA, adult participants and were relevant to the hospital setting were included in the review. Secondary and grey sources of literature were excluded. The search strategy, including the databases, key search terms, and the number of articles found using this method, are shown in Table 1. The search yielded 299 articles, which was revised to 236 after duplicates were removed. The title and abstract of all articles were screened to determine if appropriate to include them in this review. A further four articles were sourced by snowball sampling. The majority of the rejected articles (n = 213) were excluded because they were secondary research, reported on clinical capacity/competency of medical professionals, focused on pediatric patients, or were not in a hospital setting. A second, full-text review was conducted, and a further 12 articles were excluded because they were secondary research (n = 2), not relevant to PICO question (n = 16), not relevant to hospital patients (n = 17), or were a single case study (n = 18). See Figure 1 for the PRISMA flow diagram. Figure 1 shows a summary of the search process. Charting the data, collating, summarising, and reporting the results The following data were extracted: authors, year of publication, country, design/method (research design, data collection methods, and data analysis), sample/population (number, recruitment based on the gender, healthy/ill population, and setting/s), DMCA tools, and recommendations. One of the authors (TS) extracted the data, which was cross-checked by the other authors to decrease bias in reporting and data imprecision. Characteristics of studies were summarised including countries where studies were conducted, sample size, and range of DMCA tools used. Thematic analysis was conducted with coding and categorisation to explore themes that arose from the studies.

Paul Butterworth (top), and Nasim Salehi

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology