Improving mental capacity assessment: iterative, user-centred design of a toolkit and examination of its use in clinical practice.

Introduction: The Mental Capacity Act (MCA, 2005) requires health and social care professionals to complete a mental capacity assessment if a patient appears to have difficulty making decisions. This thesis explores current practice variations and professionals’ support needs and describes the development and testing of the Mental Capacity Assessment Support Toolkit (MCAST). Aims: To develop a toolkit to facilitate and improve mental capacity assessment and test the feasibility of its use in healthcare settings. Method: A sequential, mixed methods design was employed. Published research evidence and case law were reviewed. Multidisciplinary healthcare professionals were interviewed about their practice in focus groups. This evidence informed a design specification for the MCAST. User-centred design methods were employed to develop the prototype MCAST. Design modifications were identified from survey, interview and ethnographic data collected during professional, service user and topic expert reviews of prototype iterations. Professionals piloted using the MCAST to assess hospital and intermediate care patients. Document analysis, professional surveys and patient and family carer interviews were used to investigate the MCAST’s usability, acceptability and its effects on compliance with the MCA and professionals’ confidence levels. Results: The reviews and focus group data identified barriers and facilitators to good practice and suggested that current practice varies and professionals require support to improve their assessments, especially for patients with communication disorders. The MCAST was designed to enable professionals to: i) prepare, complete and document capacity assessments; ii) identify and support patients with communication disorders during capacity assessments. Most professional participants reported that the MCAST was easy to use and helped them to assess capacity. The MCAST was considered acceptable and potentially beneficial by all patients and family carers interviewed. Use of the MCAST was associated with improved assessment documentation and increased professional confidence. Conclusion: This study provides new knowledge about capacity assessment, especially in relation to people with communication disorders. The MCAST appears feasible to use in healthcare settings. Further research to refine the prototype and test its effectiveness is warranted.