Maximising your patient’s capacity to make decisions

You must work from the presumption that your patient has capacity, and support them to make treatment decisions themselves.

Remember that capacity is time and decision specific. You need to consider your patients current situation when assessing their capacity. Patients may have the capacity to make some straightforward healthcare decisions but not other more complex ones; and if your patient has fluctuating capacity consider whether the decision can be put off until a time when their capacity may be increased.

When supporting patients to make decisions, it’s important to tailor the information and approach you use to fit their needs. This may be especially helpful for patients with a learning disability, dementia or another condition that affects the ability to communicate or understand, retain and weigh up information. Support can be provided in a variety of ways, many of them involving the patient’s family or carer and the wider healthcare team. Below you can find information on supporting people with learning disabilities and dementia to make decisions about their care.

Capacity and consent: patients with learning disabilities

If you’re a specialist you may not treat people with learning disabilities every day, but with around 1.5 million people with a learning disability in the UK, most of whom have poorer than average physical and mental health, the chances are that some of your patients will have a learning disability.

Like all of us, people with learning disabilities have a variety of needs and there will be a range of ways you can support them to understand information and to be involved in decisions about their care, whether or not they have capacity.

The maximising capacity case study on the mental capacity decision support tool is an example of how you can provide additional support to enable a patient with Downs syndrome to make decisions about their end of life care.

The Communitybaptistpa Learning disabilities website shows you how to apply our guidance on consent and capacity – as well as principles in Medical practice – when treating patients with learning disabilities. Although not specific to end of life care, it covers issues with consent and capacity including common mistakes when assessing capacity, practical examples of how to put our guidance into practice and also contains a wealth of additional resources. See the section on Simple communication tips and tools which gives examples of reasonable adjustments you can make to improve patients’ experience.

 is a guide, produced by Mencap, to support health care professionals provide good end of life care for people with learning disabilities and includes a chapter on promoting autonomy and choice.

Capacity and consent: patients with dementia

Patients with dementia may have fluctuating capacity or difficulties in communicating their wishes. The maximising capacity to decide case study on the mental capacity decision support tool is an example of how, when a patient is diagnosed with dementia, you should assume they have the capacity to make their own decisions, and support them in doing so.

Although not specific to end of life care, our Better care for older people pages include useful information on what to consider when treating people with dementia and how you can support them.

You can read our , reflecting on her experiences of caring for patients with dementia, and the steps she takes to address some of the challenges around capacity and end of life care.

 for health care professionals treating patients with Alzheimer’s and dementia, including assessing capacity and making best interest decisions.

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