Clinical assessment of decision-making capacity in acquired brain injury with personality change.
Gareth S Owen, Fabian Freyenhagen, Wayne Martin and 1 others
PMID 26088818WHAT IT FOUND
Men with brain injury and personality change could show awareness of deficits in interview, yet awareness often did not guide decisions at the time.
Assess capacity by asking whether awareness is usable during deliberation, not only whether it is present.
Key findings
01Patients showed awareness of their deficits and thinking about their own thinking during interviews.
02Awareness relevant to decision-making capacity must be present at the time of the decision, not merely remembered afterwards.
03Even awareness present at the time of decision may fail to guide behaviour unless it is integrated into deliberation.
STILL TO COME
How it was doneWhat they found
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What it does not show
The sample was very small and included only men. There was no comparison group. Participants had a wide range of time since injury and different brain injuries. The method is interpretative; it generates ideas rather than measures effects. The emotional findings were not conclusive.
The easy way to misread this
Do not read a patient's ability to describe deficits in interview as evidence that they have decision-making capacity. The study found awareness can be present yet not usable during the decision itself.