Capacity to Make a Decision about Discharge Destination after Stroke: a Pilot Study

Objective: To investigate the effect of cognitive problems and other factors on the capacity to make a decision about discharge destination and to compare the impressions of multidisciplinary team (MDT) members regarding capacity with a formal assessment.Design: Between-subjects comparison design.Setting: One stroke rehabilitation unit.Subjects: Thirty-four stroke patients.Procedure: For six months, all patients admitted to a stroke rehabilitation unit were asked to take part after one week and assessed on the outcome measures.Main outcome measures: The multidisciplinary team completed questionnaires regarding risk, capacity and referral plans. All participants had a cognitive assessment. Capacity was assessed blind to the results of the cognitive assessment and independently rated by another assessor. Clinical and demographic information were collated.Results: No significant association was found between cognitive functioning and capacity (P>0.05). Age, weeks post-stroke, Barthel and dysphasia were not significantly associated with capacity (P>0.05). Multidisciplinary team members were often unsure about the capacity of people to make decisions. Inter-rater reliability for the capacity assessment was reasonable (72%; P=0.06).Conclusions: The preliminary conclusions are that cognitive test scores, age and dysphasia are not good predictors of capacity to decide about discharge destination in stroke patients receiving rehabilitation. Impressions of capacity should not be used to determine the need for a formal capacity assessment.