{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:24:00Z","timestamp":1789021440153,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2024,7]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision\u2010making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best\u2010practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision\u2010making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real\u2010life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)\u2010related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment.<\/jats:p>\n <\/jats:sec>\n \n Methods & Procedures<\/jats:title>\n Four naturally occurring capacity assessments were video\u2010recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision\u2010making capacity. The analysis was informed by our knowledge of the MCA best practice guidance.<\/jats:p>\n <\/jats:sec>\n \n Outcomes & Results<\/jats:title>\n An overall structure of capacity assessment that enacted some of the best\u2010practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option\u2010listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub\u2010components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented.<\/jats:p>\n <\/jats:sec>\n \n Conclusions & Implications<\/jats:title>\n CA is a feasible empirical method for exploring the structure and conduct of capacity assessments. CA identifies and provides ways of describing interactional behaviours that align with and diverge from best\u2010practice MCA guidance. Future CA studies including a wider range of health and social care professionals and patients have the potential to inform evidence based training for HCPs who conduct assessments of decision\u2010making capacity.<\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on this subject<\/jats:title>\n \n \n \n The Mental Capacity Act (MCA) is poorly implemented in practice. Healthcare professionals (HCPs) find it challenging to assess the decision\u2010making capacity of individuals with communication difficulties, and people with communication difficulties are often excluded from or insufficiently supported during capacity assessment. Research is limited to self\u2010report methods. Observational studies of capacity assessment are required.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n What this study adds<\/jats:title>\n \n \n \n This is the first study to use Conversation Analysis (CA) to explore how capacity assessments are conducted in a hospital setting by HCPs with people with communication difficulties as a result of acquired brain injury. One video\u2010recorded capacity assessment was structured in six phases that aligned with best practice MCA guidance. However, other capacity assessments deviated from this structure. One phase, option listing, varied in practice and options were not always presented.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n What are the clinical implications of this work?<\/jats:title>\n \n \n \n CA revealed interactional behaviours that align with and diverge from best\u2010practice MCA guidance. Future CA studies are warranted to inform training for health and social care professionals who conduct capacity assessments.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.13020","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T13:25:18Z","timestamp":1708435518000},"page":"1612-1627","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Using Conversation Analysis to explore assessments of decision\u2010making capacity in a hospital setting"],"prefix":"10.1111","volume":"59","author":[{"given":"Jessica","family":"Foulkes","sequence":"first","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4149-409X","authenticated-orcid":false,"given":"Anna","family":"Volkmer","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Beeke","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/17549507.2013.871751"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.SOCSCIMED.2017.09.014"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/08351813.2014.925667"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/02687038.2018.1486379"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699206.2019.1705915"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/14614456221110669"},{"key":"e_1_2_9_8_1","volume-title":"The business of talk\u202f: Organizations in action","author":"Boden D.","year":"1994"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/02687038.2020.1819954"},{"issue":"1","key":"e_1_2_9_10_1","first-page":"78","article-title":"Are clinicians ever biased in their judgments of the capacity of older adults to make medical decisions?","volume":"33","author":"Braun M.","year":"2009","journal-title":"Generations (San Francisco, Calif.)"},{"issue":"2","key":"e_1_2_9_11_1","first-page":"102","article-title":"Decisional capacity assessment","volume":"34","author":"Braun M.","year":"2010","journal-title":"Generations (San Francisco, Calif.)"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0190272510379838"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2012.11.009"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511607172"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15327027hc1902_1"},{"key":"e_1_2_9_16_1","unstructured":"House of Lords. (2014)Select Committee on the Mental Capacity Act 2005 Report of Sessions 2013\u20132014.London:Authority of the House of Lords. Available at:https:\/\/publications.parliament.uk\/pa\/ld201314\/ldselect\/ldmentalcap\/139\/13902.htm"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/00208825.2001.11656821"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2016.1224275"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1572793"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1075\/pbns.125.02jef"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781003069652"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2017.1379613"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/02687038.2017.1355441"},{"key":"e_1_2_9_24_1","unstructured":"Mental Capacity Act. (2005) Available from:https:\/\/www.legislation.gov.uk\/ukpga\/2005\/9\/contents"},{"key":"e_1_2_9_25_1","unstructured":"Mental Capacity Act 2005 Code of Practise. (2007) Available from:https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/921428\/Mental\u2010capacity\u2010act\u2010code\u2010of\u2010practice.pdf[Accessed 22nd July 2022]."},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/02687038.2020.1759772"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/09503153.2015.1074667"},{"key":"e_1_2_9_28_1","unstructured":"National Institute for Health and Care Excellence(2018)Supported decision making and mental capacity[NG108]. Available from:https:\/\/www.nice.org.uk\/guidance\/ng108[Accessed 22nd July 2022]."},{"key":"e_1_2_9_29_1","unstructured":"NHS England. (2016)Accessible information standard. 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