616 Informed consent/legal considerations (Samuelson 4/3)

T/F: You should always assume pt does NOT make own decisions until otherwise, even if caregiver is present

False - always assume pt does make own decisions until otherwise

Define power of attorney

Principle Appointed individual who has legal power to make financial or health care decisions if you become incapacitated.

Define guardianship

Court appointed substitute decision maker if an adult becomes incapable of making responsible decisions due to mental disability.

Why cognitive impairment matters?

- Increase difficulty in clinical management

-- Disruptive behaviors, Comorbidity, Polypharmacy

- Increase risk of complications

- Ability to give informed consent for treatment? "Capacity"

Domains of informed consent (3)

- Clinical competence of pt

- Voluntary not coerced

- Appropriate information

Items that are important to disclose in informed consent

- Diagnosis

- Nature, risks, costs, benefits of txt

- Alternative txt

- Likelihood of success

- Prognostication - diagnostic process involves the person, mouth, teeth

How to determine decision-making capacity of pt?

Can the pt...

- make and express personal preferences at all?

- comprehend risks and benefits?

- comprehend the implications?

- give reasons for the alternative selected?

- Are supporting reasons rational?

What should you do if you are unsure of pt's decision making capacity?

Call physician - conservative investigations

Mental status exam - ASSET

A - Appearance, behavior

S - Speech

S - Sensorium (Cognitive-memory, orientation, calculation

Perceptual-hallucinations, illusions

Intellectual-abstract thinking, judgment etc.)

E - Emotional function

T - Thought, processes

Mental status exam - technique (4)

- Observation

- Listening

- Active questioning

- Melded into a normal interview

3 disorders with impaired competency

- Cognitive disorders

- Emotional disorders

- Thought impairment

Types of cognitive disorders (2)

- Dementia (decline in memory and cognitive function)

- Delirium (cognitive change or perceptual disturbance; hyperactive or hypoactive)

Screening for cognitive impairment - what tests are used?

- MMSE (Mini-mental state examination; 30 pt questionnaire)

- Mini-cog

Mini cog scoring

Types of emotional disorders (2)

- Depression

- Mania

Mania is part of ___________ disorder

Bipolar

- elevated mood, rapid speech, grandiosity

- impaired judgement

With which condition does a pt often feel hopeless about txt?

Depression

Characteristics of schizophrenia

- Impaired thought production

- Paranoia

- Perceptual disturbances

- Poor motivation

- Poor social skills

- Impaired reality

T/F: Competence is legally assumed until proven otherwise

True