Evaluation of the MCAST, a multidisciplinary toolkit to improve mental capacity assessment

Abstract

Purpose

To evaluate the usability and acceptability of the Mental Capacity Assessment Support Toolkit (MCAST) in healthcare settings and whether its use was associated with increased legal compliance and assessor confidence.

Materials and methods

A mixed methods convergence triangulation model was used. Multidisciplinary professionals used the MCAST during mental capacity assessments for UK hospital patients with diagnoses of stroke or acute or chronic cognitive impairment. Changes in legal compliance were investigated by comparing scores on case note audits before and after implementation of the MCAST. Changes in assessor confidence and professionals’ perceptions of the MCAST’s usability and acceptability were explored using surveys. Patients’ and family members’ views on acceptability were determined using semi-structured interviews. Data were integrated using triangulation.

Results

Twenty-one professionals, 17 patients and two family members participated. Use of the MCAST was associated with significant increases in legal compliance and assessor confidence. Most professionals found the MCAST easy to use and beneficial to their practice and patients. Patients and family members found the MCAST materials acceptable.

Conclusions

The MCAST is the first toolkit to support the needs of individuals with communication disabilities during mental capacity assessments. It enables assessors to deliver high quality, legally compliant and confident practice.

IMPLICATIONS FOR REHABILITATION

• Mental capacity assessment practice needs to be improved to maximise patient autonomy, safety and well-being.

• The MCAST is a paper-based toolkit designed to facilitate and improve mental capacity practice in England and Wales.

• This study suggests the MCAST would be easy and acceptable to use in healthcare settings and could lead to improvements in assessment quality and assessor confidence.

Keywords:

• Cognition disorders
• communication disorders
• decision making
• informed consent
• mental competency
• neurological rehabilitation

Acknowledgements

The authors would like to thank the patients, family members and professionals who took part in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Mark Jayes was funded by an NIHR Clinical Doctoral Research Fellowship.