Patient Values Influence Clinician Judgment of Medical Decision-Making Capacity

OBJECTIVES: Medical decision-making capacity assessments commonly focus on patient communication, understanding, appreciation, and reasoning, with less emphasis on patient values or preferences that could influence their medical decision. The current study investigates the role of patient values in capacity assessments. METHODS: One hundred and ten clinicians with experience conducting medical decision-making capacity assessments completed an online survey. Participants read two vignettes about a patient with questionable capacity and were asked to determine whether the patient had capacity. For the second vignette, participants were randomly assigned to read a vignette which contained information about the patient's longstanding values or a vignette without this information. RESULTS: When information about the patient's values and preferences was included in the vignette, participants were significantly more likely to determine the patient had capacity to make a medical decision. Other significant contributors to a clinician's judgment included experience conducting medical decision-making capacity assessments in a VA hospital and whether the clinician prioritized the patient's autonomy or their health and safety. CONCLUSIONS: A patient's values and preferences provide important context which significantly influences clinician judgment of capacity. CLINICAL IMPLICATIONS: Clinicians should regularly assess a patient's values and preferences when conducting capacity assessments, as this may promote patient autonomy.