Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
Department of Occupational Medicine, University of Alberta, Edmonton, AB, Canada.
JMIR Form Res. 2024 Nov 25;8:e60574. doi: 10.2196/60574.
With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually.
This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic.
We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics.
There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties.
Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach.
随着老年人口的增加，预计痴呆症患者的数量将会增加。因此，需要进行决策能力评估（DMCA）的人数将会增加。COVID-19 大流行影响了我们提供患者护理的方式，包括更快速地转向虚拟评估。虚拟 DMCA 通过改善可达性、可及性和及时提供医疗保健，为患者和医疗保健专业人员提供了与面对面交付不同的优势。然而，人们对于虚拟评估是否能够有效地进行产生了疑问。
本研究旨在确定在 COVID-19 大流行期间进行虚拟 DMCA 的特点、障碍和促进因素。
我们于 2022 年 3 月至 2023 年 2 月期间，对艾伯塔省进行 DMCA 的医疗保健提供者进行了一项在线调查。该调查包含 25 个关于人口统计学、偏好以及虚拟进行 DMCA 的经验问题，以及进行虚拟 DMCA 的风险和障碍问题。使用描述性统计方法对数据进行分析。
有 31 名参与者，平均年龄为 51.1（SD 12.7）岁。参与者包括医生（45.2%，14/31）、职业治疗师（29%，9/31）和社会工作者（16.1%，5/31），其中大多数（93.6%，29/31）位于埃德蒙顿。进行 DMCA 的平均年限为 12.3（SD 10.7）年，中位数为每年进行 8 次 DMCA（IQR 18.5）。大多数受访者进行能力访谈，其中大多数（55.2%，16/29）主要与急性护理服务相关。此外，54.8%（17/31）有兴趣进行虚拟 DMCA；然而，只有 25.8%（8/31）进行过虚拟 DMCA。虚拟 DMCA 的障碍和促进因素与患者的特征和环境有关（例如沟通困难、听力或视力障碍、语言障碍、技术易用性或认知障碍）、技术和技术支持（客户和评估者双方都需要技术支持、农村地区互联网连接不可靠以及高保真度设备的可用性）以及评估者进行虚拟 DMCA 的能力（进行 DMCA 时观察肢体语言、在需要时与客户进行身体互动以及建立融洽关系的能力都可能受到影响）。在临床实践方面，建议患者或照顾者熟悉技术、拥有稳定的互联网连接、使用私人房间、不被录音、使用标准化评估模板，并在遇到技术困难时制定备用计划。
进行虚拟 DMCA 是一项相对较少的工作。需要解决充分评估的障碍和促进因素，因为虚拟评估既节省时间又扩大了服务范围。
