Decision-making capacity in aphasia: SLT’s contribution in England

Figures & data

Figure 1. Data from the questionnaire on (a) awareness of MCA, and SLTs’ confidence in undertaking capacity assessments (upper panel); (b) role and utilisation of SLTs in capacity assessment for PWA (middle panel); and (c) types of decisions (and proportion) in which SLTs’ expertise were sought (lower panel).

Table 1. SLTs’ capacity assessment training and their role in inter-professional training.

	Yes	No
SLTs received training on capacity assessment	84% (47)	16% (9)
Provider of the training	Organisation’s mandatory requirement	SLT-specific training
	85% (49)	15% (7)
Length of training	1–2 h	Half day	> Half day
	53% (25)	41% (19)	6% (3)
Recency of training	No training	Within the last year	Within the last 3years	> 3 years ago
	16% (9)	39% (22)	43% (24)	2% (1)
Preferred delivery method of training	Face-to-face	Online	No preference
	77% (43)	11% (6)	12% (7)
	Yes	No
Are there knowledge gaps?	68% (38)	32%(18)
SLTs provided training to other team members	38% (21)	62% (35)
Service received additional funding for supporting capacity training	0% (0)	100% (56)

Table 2. Areas of knowledge gaps identified and resources needed by SLTs for capacity assessments in PWA.

Areas of gaps	Examples of respondents comments
The Act (7)	“We need advice on what to do if the MCA is not being followed and examples of this. The training we have received and the act itself doesn’t explain this well enough.”
	“There is a problem with assessing capacity those cases that are borderline as these are always the trickiest. The process is very clear for patients who clearly don’t have capacity but it is harder to feel confident in exactly what is required of each step when someone is more borderline, or for example where they do not want to engage in discussions about the risks – e.g. if they are in denial or are indecisive on different days (which sometimes feels a reasonable and normal reaction rather than a sign that someone lacks capacity).”
Training (9)	“Training isn’t updated often enough. It’s normally the consultants view or someone with a role that is ‘better understood’ who’s decision is taken as final. There is a lack of respect for SLTs in some places I’ve worked in and our insight into communication can be ignored because some professions aren’t aware of our expertise. Training and educating professionals is necessary.”
	“MCA training needs to be a part of all trust inductions. The last 3 trusts haven’t had that.”
	“Joint training with other MDT^2 and the individual roles of each profession in assessments.”
Inter-professional understanding (7)	“The gaps are in the knowledge of other professionals in understanding how SLTs can help support aphasics in particular as well as our expertise in aiding other conditions.”
	“The wider MDT^2’s have a lack of understanding of the role of SLTs and when to consult them.”
	“More training to other professionals is needed from SLTs. We can explain conditions such as aphasia e.g.: ‘no doesn’t always explicitly mean no. There is complexity to conditions that some people see past.”
Confidence (6)	“There is a lack of confidence, I have witnessed in my team, as such an important decision often feels like it comes down to an SLT’s assessment, and therefore so crucial that it is done properly.”
	“Confidence in carrying out assessment. Not everyone has been trained yet we are expected to carry out these decisions.”
	“There is a general lack of confidence due to inexperience and lack of specific training to SLTs and MDT.”
Resources (5)	“Profession specific resources would really help … There is a lack of this at our hospital which means alternative needs are relied on, this is not always the most effective.”
	“We need to regularly update our knowledge re mental capacity. In particular, published resources would be useful to support capacity assessments.”

Number in the parenthesis represents the number of participants who commented on this theme.

MCA = Mental Capacity Act; MDT = Multidisciplinary Team.

Figure 2. Proportion of team members trained by SLTs to support capacity assessment in PWA (upper panel, a), and proportion of referrals from various team members who sought SLTs’ support for capacity assessments in PWA (lower panel, b).