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The decision-making abilities, their definitions, and questions to assess them

The decision-making abilities, their definitions, and questions to assess them
Decision-making ability Definition Sample questions
Understanding The ability to state the meaning of the relevant information (eg, diagnosis, risks and benefits of a treatment or procedure, indications, and options of care). After disclosing a piece of information, pause and ask the patient: "Can you tell me in your own words what I just said about [fill in the topic disclosed]?"
Expressing a choice The ability to state a decision. "Based on what we've just discussed about [insert the topic], what would you choose?"
Appreciation The ability to explain how information applies to oneself.

To assess appreciation of diagnosis: "Can you tell me in your own words what you see as your medical problem?"

To assess appreciation of benefit: "Regardless of what your choice is, do you think that it is possible the medication can benefit you?"

To assess appreciation of risk: "Regardless of what your choice is, do you think it is possible the medication can harm you?"
Reasoning The ability to compare information and infer consequences of choices.

To assess comparative reasoning: "How is X better than Y?"

To assess consequential reasoning: "How could X affect your daily activities?"
Instructions: The usual flow of a capacity assessment begins with the clinician disclosing the relevant facts for a decision and an assessment of the patient's understanding of those facts. Next, the clinician asks for the person's choice, followed by an assessment of their appreciation and reasoning about the choice, and concluding with a reassessment of choice. During the reassessment of choice, pay attention to the logical consistency of the choice based on the reasoning provided.
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