Journal Article Annotations
2022, 4th Quarter
Annotations by Jai Gandhi, MD
This retrospective study, at a single tertiary care medical center, attempted to examine racial disparities in decisional capacity consultations across four domains. These four domains were the request for capacity consultation, a capacity evaluation (completed by the C-L psychiatry team), an impaired capacity determination, and a change in the current treatment plan (as a result of the impaired capacity determination). Black and Hispanic patients (as documented by the C-L psychiatry team) were disproportionately represented in capacity consultations in comparison to the demographic makeup of inpatient admissions across the same time period. There were no significant racial disparities for capacity evaluations, impaired capacity determinations, or changes in the treatment plan. Patients with less than a high school diploma were more likely to have no change in their treatment trajectory after an impaired capacity determination. Unsurprisingly, the diagnosis of delirium was significantly associated with an impaired capacity determination.
Strength and weaknesses:
Unfortunately, as a study within a single medical center, the generalizability of these results is limited, and whether or not the study achieved the sample size necessary to have adequate power to appropriately assess the relevant outcomes is unclear. The study’s determination of “no change” in treatment trajectory as a negative outcome is questionable; capacity consultation requests are complex, involve numerous variables, and the treatment trajectory after the impaired capacity determination is relative to the decision that was necessary for the patient to make. Nonetheless, this study is a unique contribution to C-L literature on racial disparities that warrant the attention of both C-L psychiatrists and their consulting colleagues.
C-L psychiatrists should be thoughtful about capacity consultation requests for Black and Hispanic patients as this study determines these populations may be overrepresented in capacity consultation requests. Examining factors that may have led to the capacity consultation request will be important given the racial disparities this study uncovered.