Date on Master's Thesis/Doctoral Dissertation

8-2025

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Mast, Benjamin

Committee Member

Midden, Allison

Committee Member

Stetson, Barbara

Committee Member

Walter, Bernadette

Author's Keywords

Medical decision-making capacity; capacity

Abstract

A medical decision-making capacity (MDC) assessment is the assessment of an individual to determine whether they can make their own medical decisions or if a proxy decision maker must make care decisions on their behalf. These assessments are necessary when individuals experience cognitive impairments which limit their ability to think through complex medical decisions. Best practice for MDC assessments is a growing area of research, with no standard approach to guide assessment planning. The current study builds upon the field’s knowledge of capacity assessments by investigating 1) what methods and measures clinicians utilize in capacity assessments, 2) what factors influence a clinician’s judgment of capacity, and 3) the role of patient values in capacity assessments. 110 clinicians with experience conducing MDC assessments completed an online survey describing how they typically conduct capacity assessments. Participants overwhelmingly reported they assess communication, understanding, appreciation, and reasoning. There was variability in how often other elements were included in typical MDC assessments. The Aid to Capacity Evaluation (ACE) was the most frequently used tool in MDC assessments, but almost half (44.3%) of participants reported they did not use any MDC tool. Participants read two vignettes about a patient with questionable capacity and were asked to determine whether the patient had capacity. When information vi about the patient’s values and preferences was included in the vignette, participants were significantly more likely to determine the patient had capacity to make a medical decision. Other significant contributors to a clinician’s judgment included experience conducting MDC assessments in a VA hospital and whether the clinician prioritized the patient’s autonomy or their health and safety. This study highlights the role clinician-level factors can play in MDC determinations, with clinicians who value autonomy being more likely to determine a patient has capacity in comparison to clinicians who prioritize health and safety. Additionally, values and preferences were an important consideration in the study vignette, suggesting a patient’s values and preferences provides important context and clinicians should regularly include them in capacity assessments. Standardized approaches could reduce clinician subjectivity and increase the consistency of incorporating values in MDC assessments.

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