School of Humanities & Social Sciences, University of Newcastle, Callaghan, Australia.
Int J Lang Commun Disord. 2010 Mar-Apr;45(2):244-58. doi: 10.3109/13682820902936714.
The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist.
The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations.
The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software.
The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication.
The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area.
当需要评估和管理一个有语言障碍的人，且对其决策能力存在疑问时，这是一个极具挑战性的临床问题。此外，目前针对这一问题，仅有少量的相关指南和经验研究可供参考。
本研究旨在确定语言病理学家在面对有语言障碍的患者的法律和相关事务的决策能力问题时，所面临的主要问题，并定性描述这些问题的性质以及语言病理学家在这些情况下的实践情况。
本研究采用定性研究范式，并利用关键事件技术中开发的半结构化访谈方法。通过电话采访了 9 名语言病理学家，他们的临床经验从 3 年到 27 年不等，采访记录由采访者在线记录。语言病理学家总共描述了 21 名患有后天性神经沟通障碍（包括脑血管意外、创伤性脑损伤和肿瘤）的患者（15 名男性，6 名女性），这些患者的护理曾引发过与法律和相关事务有关的关键事件。这些逐字记录使用 NVivo 定性分析软件进行了定性分析。
主要的事件涉及法律决策（例如，授权书、遗嘱）以及涉及医疗、出院、住宿和商业/财务决策的同意。在所有描述的事件中，除了一个事件之外，问题都集中在语言障碍者与他们的家人、朋友或多学科团队之间的冲突情况。语言病理学家所扮演的角色包括在语言病理学实践范围内的角色，如评估师和顾问，以及可能会出现困境和利益冲突的角色，如口译员、倡导者。评估实践涉及一些标准化测试，但所有参与者都强调，这比功能的非正式观察要次要。语言病理学家强调了多次观察和多模态沟通方式的重要性。
研究结果表明，当涉及到有语言障碍的人进行法律和相关决策的能力问题时，语言病理学家目前正在发挥积极作用。同时，研究结果支持需要进一步研究，以制定实践指南，并为学生和新手临床医生提供教育经验，以帮助他们处理该领域的复杂案例管理问题。
