Consent guidance: Maximising a patient’s ability to make decisions

1. 66. A patient’s ability to make decisions may depend on the nature and severity of their condition, or the difficulty or complexity of the decision. Some patients will always be able to make simple decisions, but may have difficulty if the decision is complex or involves a number of options. Other patients may be able to make decisions at certain times but not others, because fluctuations in their condition impair their ability to understand, retain or weigh up information, or communicate their wishes.
2. 67. If a patient’s capacity is affected in this way, you must follow the guidance in paragraphs 18–21, taking particular care to give the patient the time and support they need to maximise their ability to make decisions for themselves. For example, you will need to think carefully about the extra support needed by patients with dementia or learning disabilities.
3. 68.  You must take all reasonable steps to plan for foreseeable changes in a patient’s capacity to make decisions. This means that you should:
   1. a. discuss treatment options in a place and at a time when the patient is best able to understand and retain the information
   2. b. ask the patient if there is anything that would help them remember information, or make it easier to make a decision; such as bringing a relative, partner, friend, carer or advocate to consultations, or having written or audio information about their condition or the proposed investigation or treatment
   3. c. speak to those close to the patient and to other healthcare staff about the best ways of communicating with the patient, taking account of confidentiality issues.
4. 69. If a patient is likely to have difficulty retaining information, you should offer them a written record of your discussions, detailing what decisions were made and why.
5. 70. You should record any decisions that are made, wherever possible while the patient has capacity to understand and review them. You must bear in mind that advance refusals of treatment may need to be recorded, signed and witnessed.