Decision-making capacity and aphasia: speech-language pathologists’ perspectives
Bibliographic record
Abstract
Background: In health care settings, a person’s ability to make decisions may be questioned as a result of neurological disease or injury that can affect cognitive function. To determine whether a person is able to make a decision, health care professionals are required to carry out an assessment of decision-making capacity (DMC; also known as capacity assessments). For individuals with aphasia, these types of assessment may be problematic because they rely heavily on language abilities. There is a growing body of literature available on capacity assessments of individuals with aphasia, yet there are few studies on the perspectives of speech-language pathologists (SLPs) related to DMC assessments of individuals with aphasia, including barriers and facilitators to valid assessments.Aims: The purpose of this study was to explore perspectives of SLPs on assessments of DMC with individuals with aphasia. The following research questions were of interest: (1) What do SLPs know about capacity assessment? (2) What are the perspectives of SLPs regarding the current state of capacity assessment of individuals with aphasia? (3) What recommendations do SLPs have regarding the assessment of DMC of persons with aphasia (PWA)?Methods and Procedures: In the context of a qualitative research paradigm, researchers carried out semi-structured interviews with 15 SLPs in Alberta, Canada. An interpretive description design was used for data analysis and interpretation.Outcomes and Results: Participants discussed three major topics: (1) knowledge of capacity of assessments; (2) assessments of DMC and PWA; and (3) involvement of SLPs in capacity assessments. Participants had very general knowledge of capacity assessments. Participants reported that they thought that PWA were at a disadvantage during capacity assessments. Participants recognised that SLPs have professional skills that enable them to enhance assessment of DMC in PWA. The results of this study confirm and extend findings from other international research studies.Conclusions: SLPs should be involved in capacity assessments for PWA. Their knowledge in the areas of communication and cognition are important to facilitate fair, valid capacity assessments. The findings of this study may be used to inform recommendations for SLPs to assume different roles in the capacity assessment process.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.047 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.014 | 0.032 |
| Scholarly communication | 0.011 | 0.010 |
| Open science | 0.003 | 0.013 |
| Research integrity | 0.006 | 0.012 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".