Supported decision making
Chapter 3, 3.10 of the MCA Code of practice (2007) provides specific communication guidance for professionals to support decision-making some of which is appropriate for most people. However, different communication strategies for people with different diagnosis and communication difficulties may be needed.
Try out a support strategy in a conversation that is not about the important decision the individual is about to make before moving on to the important decision as introducing a new strategy without preparation could be detrimental. Do not head straight into the important stuff; make sure you have a general conversation to introduce yourself, build rapport and check equipment, such as a hearing aid, is working.
The following is adapted from the MCA Code of practice (2007) General Communication Guidance (pp.32-33)
Ask people who know the person well about:
- The best way and time for communication.
- Whether the individual uses a hearing aid, glasses or other sensory device.
- What aspects of the decision in question will be difficult for the individual to understand and what would they suggest you can do to help
Specific care or nursing staff members are sometimes able to communicate well with certain people and there may be specialist support workers who have more knowledge of the person’s cognitive and communication needs and strengths.
When communicating do
- Use straight forward language and relevant pictures, objects or illustrations to demonstrate ideas.
- Use active instead of passive language
- Use common phrasing
- Use literal language not euphemisms
- Use single words if you are confident this will benefit the person’s understanding
- Speak at the right volume
- Speak at a routine speaking pace; slowing down often does not help a person to understand information, as it creates a bigger burden on a person’s memory
- It may be helpful to pause to check understanding or show that a choice is available.
- Break down difficult information into smaller points that are easy to understand.
- Allow the person time to consider and understand each point before continuing.
When communicating do not
- Use patronising or overly emphatic pitch or tone
- Use childlike language a
- Use medical vocabulary
Family or friends who are acting as interpreters may provide additional information. Professional interpreters are trained to translate directly, without modifying information. It is good practice to meet with an interpreter prior to meeting a client to agree that this is particularly important for decision-making.
It may be necessary to repeat, rephrase, present information in a different way, or go back over a point several times.
Be aware of and respect these factors that shape a person’s way of thinking, behaviour or communication:
1 Reflecting on values and bias within mental capacity decision-making
2 The history and current context of mental capacity legislation and policy
3 The concept of mental capacity
4 Best interests
5 Supported decision making
6 Deprivation of liberty: human rights
7 MCA in clinical decisions for care and treatment
8 MCA and the Office of the Public Guardian (OPG) role