Clinician perspectives on decision-making capacity after acquired brain injury.
Acquired brain injury frequently alters an individual's ability to make health care decisions based on a clear understanding of the situation and options. This exploratory study investigated the ways health care providers address issues of decisionmaking capacity (DMC) on a daily, functional basis. 33 clinicians providing rehabilitation services to persons with acquired brain injury participated in 1 of 5 semi-structured focus groups. All 33 participants, representing 8 different occupations, agreed that DMC determinations affected their practice every day. Participants underscored a multidimensional rather than a unitary definition of DMC, with an emphasis on fluctuating capacities due to the injury. Important concerns were for the safety of the person with brain injury, the health care provider, and community members. Other themes included rehabilitation team involvement, family context, and professional socialization. Clinical determinations of DMC are context dependent and are affected by the abilities of the individual and the substance and consequences of the decision being made and include the concepts of regaining trust and reclaiming capacity.
Mukherjee
Debjani
D
Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation and Program in Medical Humanities and Bioethics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
McDonough
Carol
C
D000328:Adult; D001076:Aptitude; D001291:Attitude of Health Personnel; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation; D003657:Decision Making; D005195:Family Relations; D017144:Focus Groups; D006801:Humans; D016743:Mental Competency; D008875:Middle Aged; D010351:Patient Discharge; D011340:Problem Solving; D012951:Socialization