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Approche gériatrique globale / Mieke Deschodt / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2015)  

Approche gériatrique globale : rôle des équipes de liaison interne gériatrique - Synthèse [printed text] / Mieke Deschodt, Author ; Veerle Claes, Author ; Bastiaan Van Grootven, Author ; Koen Milisen, Author ; Benoit Boland, Author ; Johan Flamaing, Author ; Alain Denis, Author ; François Daue, Author ; Lut Mergaert, Author ; Carl Devos , Author ; Patriek Mistiaen , Author ; Koen Van Den Heede , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2015 . - 26 p. : Ill., ; A4. - (KCE Reports B. Health Services Research (HSR); 245BS) . ISSN : D/2015/10.273/46 : € 0,00 Etude 2013-14 Languages : French (fre) Descriptors: Indexation 2013-14 ; Geriatric Assessment ; Geriatrics ; Health Services Research ; Multidisciplinary meeting (MDM) ; R245 Classification WT 100 - Geriatrics -- General works Abstract: Avec le vieillissement de la population, de plus en plus de personnes âgées doivent passer par la case « hôpital ». Certaines d’entre elles ont une santé précaire. Cette fragilité, qui porte le nom de « profil gériatrique », se mesure à l’aide de tests spécifiques. Quand elles sont hospitalisées, ces personnes doivent bénéficier d’une « approche gériatrique globale », qui accorde une attention particulière à leurs capacités cognitives, physiques et psychosociales. C’est dans cette logique qu’ont été créés les services de gériatrie (lits G). Mais ces services ne suffisent déjà plus. En outre, les personnes très âgées sont souvent hospitalisées dans des services non gériatriques, par exemple pour une prothèse de hanche, alors qu’elles nécessitent aussi des soins gériatriques. C’est pour ces raisons que des « équipes de liaison interne gériatrique » ont été mises en place il y a une dizaine d’années. Ces équipes mobiles spécialisées visitent les patients identifiés à haut risque gériatrique dans les autres services de l’hôpital pour évaluer leur état et formuler des recommandations à propos des soins à leur apporter. L’organisation et le fonctionnement de ces équipes a fait l’objet d’une évaluation par le Centre Fédéral d’Expertise des Soins de Santé (KCE). Il apparaît que la manière dont fonctionnent ces équipes est très hétérogène et que toutes les conditions ne sont pas réunies pour que leur travail soit efficace. Il faudrait notamment qu’elles puissent s’impliquer plus activement dans la mise en place des soins qu’elles préconisent. Par ailleurs, il est urgent que des mesures soient prises pour augmenter le nombre de gériatres et d’infirmiers possédant une expertise spécifique en gériatrie et, plus généralement, pour sensibiliser l’ensemble des soignants à l’approche gériatrique. Contents note: SYNTHÈSE 4 -- 1. CONTEXTE 6 -- 1.1. UNE POPULATION (HOSPITALIÈRE) VIEILLISSANTE 6 -- 1.2. LE PROFIL GÉRIATRIQUE 6 -- 1.3. LES SOINS GÉRIATRIQUES GLOBAUX : UNE APPROCHE MULTIDISCIPLINAIRE 7 -- 1.4. UN MODÈLE DE RÉFÉRENCE QUI DEVIENT INSUFFISANT 7 -- 1.5. LA LIAISON INTERNE GÉRIATRIQUE 7 -- 2. L’ORGANISATION DES SOINS HOSPITALIERS POUR LES PATIENTS GÉRIATRIQUES EN BELGIQUE 8 -- 2.1. LE PROGRAMME DE SOINS POUR LES PATIENTS GÉRIATRIQUES: CINQ APPROCHES POUR AMÉLIORER LES SOINS AUX PATIENTS ÂGÉS.8 -- 2.1.1. Le service de gériatrie aigüe 9 -- 2.1.2. La consultation de liaison interne gériatrique. 9 -- 2.1.3. Une fonction de liaison gériatrique externe 10 -- 2.1.4. Les consultations gériatriques ambulatoires. 10 -- 2.1.5. Les hôpitaux de jour gériatriques 10 -- 2.2. LES GÉRIATRES: UNE DEMANDE LARGEMENT SUPÉRIEURE À L’OFFRE.10 -- 2.3. TROP PEU D’INFIRMIERS SPÉCIALISÉS EN SOINS GÉRIATRIQUES11 3. LES DÉFIS À RELEVER POUR LES ÉQUIPES DE LIAISON INTERNE GÉRIATRIQUE12 -- 3.1. EFFICACITÉ DES ÉQUIPES DE LIAISON INTERNE GÉRIATRIQUE : DES PREUVES SCIENTIFIQUES LIMITÉES 12 -- 3.1.1. Une perception positive 12 -- 3.1.2. Un concept peu répandu au niveau international.12 -- 3.2. TANT LE MODÈLE DE SOINS QUE SON IMPLÉMENTATION SONT HÉTÉROGÈNES.13 -- 3.2.1. Hétérogénéité dans la mise en application des principes de l’approche gériatrique globale 13 -- 3.2.2. Hétérogénéité des aspects organisationnels 15 -- 3.3. DES MODÈLES DE SOINS ALTERNATIFS ÉMERGENT 17 -- 3.4. L’ÉVALUATION DE LA QUALITÉ DES SOINS GÉRIATRIQUES EN EST ENCORE À SES BALBUTIEMENTS 18 -- 4. CONCLUSIONS.19 -- RECOMMANDATIONS 20 -- RÉFÉRENCES 23 Link for e-copy: https://doi.org/10.57598/R245BS Format of e-copy: PDF (839 Kb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3557

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Appropriate care at the end of life / Kris Van den Broeck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2017)  

Appropriate care at the end of life [printed text] / Kris Van den Broeck, Author ; Olivier Schmitz, Author ; Isabelle Aujoulat, Author ; Patriek Mistiaen , Author ; Marie Friedel, Author ; Magali Genet, Author ; Céline Ricour, Author ; Laurence Kohn , Author ; Johan Wens, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2017 . - 203 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 296C) . ISSN : D/2017/10.273/90 : € 0,00 Languages : English (eng) Descriptors: Indexation 2015-14 ; Advance Care Planning ; Advance Directive Adherence ; Advance Directives ; Hospice and Palliative Care Nursing ; Hospice Care ; Life Support Care ; Medical Futility ; Palliative Care ; Palliative Medicine ; R296 ; Refusal to Treat ; Terminal Care ; Terminally Ill ; Treatment Refusal ; Withholding Treatment Classification WB 310 Hospice care. Palliative care. Terminal care Contents note: SCIENTIFIC REPORT .9 -- 1 INTRODUCTION 9 -- 1.1 GENERAL RESEARCH AIM 9 -- 1.2 POLICY RELEVANCE AND TARGET POPULATION .10 -- 1.3 RESEARCH QUESTIONS .10 -- 2 METHODOLOGY 11 -- 2.1 BUILDING UPON PREVIOUS WORK .11 -- 2.2 BELGIAN LITERATURE REVIEW .11 -- 2.2.1 Orientation of the study .11 -- 2.2.2 Search sources .11 -- 2.2.3 Search strategy .12 -- 2.2.4 In- and exclusion criteria and process 13 -- 2.2.5 Methodological assessment 13 -- 2.2.6 Data extraction 13 -- 2.2.7 Data synthesis 13 -- 2.3 ONLINE QUESTIONNAIRE 14 -- 2.3.1 Orientation of the study .14 -- 2.3.2 The questionnaire 14 -- 2.3.4 Data analysis 16 -- 2.4 QUALITATIVE FOLLOW-UP STUDY 17 -- 2.4.1 Orientation of the study .17 -- 2.4.2 Procedure .17 -- 2.4.3 Data analysis 18 -- 2.5 VALIDATION PROCEDURES 18 -- 2.6 ETHICAL APPROVAL 19 -- 2.7 OUTLINE OF THE REPORT .19 -- 3 BELGIAN LITERATURE SEARCH 19 -- 3.1 RESULTS 19 -- 3.1.1 Search results 19 -- 3.1.2 Terminology & definitions .20 -- 3.1.3 Prevalence 28 -- 3.1.4 Determinants and contributing factors 30 -- 3.1.5 Consequences 34 -- 3.1.6 Interventions 34 -- 3.2 CONCLUSIONS FROM THE LITERATURE REVIEW 36 -- 4.1 PRECEDING NOTES 38 -- 4.2 DESCRIPTION OF THE RESPONDENTS 41 -- 4.2.1 Description of the total eligible sample .41 -- 4.2.2 Sample descriptives by the perspective respondents adopted.42 -- 4.2.3 More information about respondents with a background in care .44 -- 4.3 CIRCUMSTANCES OF END OF LIFE CARE 44 -- 4.4 OPINIONS ABOUT AND ATTITUDES TOWARDS END OF LIFE CARE .46 -- 4.4.1 Who is responsible for inappropriate care? 46 -- 4.4.2 Opinions about and attitudes towards end of life care 49 -- 4.4.3 Balanced involvement in end of life care? 51 -- 4.4.4 Advance care planning regarding end of life care 53 -- 4.4.5 Preferences in decision making about end of life care .57 -- 5 QUALITATIVE ANALYSES 57 -- 5.1 CHAPTER OUTLINE AND AVAILABLE DATA 57 -- 5.1.1 Chapter outline: Three research questions .57 -- 5.1.2 Data and respondents 57 -- 5.2 RESEARCH QUESTION 1: DEFINITION OF ‘(IN)APPROPRIATE CARE AT THE END OF LIFE’ 60 -- 5.2.1 Procedure .60 -- 5.2.2 Qualitative analysis of the online questionnaire 60 -- 5.2.3 Supplementary analyses of the qualitative follow-up study 66 -- 5.2.4 Conclusion: one general definition, different accents 81 -- 5.3 RESEARCH QUESTION 2: CAUSES AND MECHANISMS UNDERLYING (IN)APPROPRIATE CARE AT THE END OF LIFE 83 -- 5.3.1 Procedure .83 -- 5.3.2 Qualitative analysis of the online questionnaire 84 -- 5.3.3 Supplementary analyses of the qualitative follow-up study 96 -- 5.3.4 Conclusion: causes and mechanisms underlying (in)appropriate end of life care 117 -- 5.4 RESEARCH QUESTION 3: SOLUTIONS FOR AND PREVENTION OF INAPPROPRIATE END OF LIFE CARE . 118 -- 5.4.1 Talking, talking, talking, and listening, listening, listening 118 -- 5.4.2 Training for health care practitioners . 119 -- 5.4.3 Organisation of care 120 -- 5.4.4 Guidance regarding ethical issues 121 -- 6 GENERAL DISCUSSION 122 -- 6.1 SUMMARY OF FINDINGS . 122 -- 6.1.1 Definition of (in)appropriate end of life care 122 -- 6.1.2 Causes and mechanisms underlying (in)appropriate end of life care 123 -- 6.1.3 Solutions for and measures to prevent inappropriate care . 124 -- 6.1.4 The weight of our findings 124 -- 6.2 LIMITATIONS 127 -- 6.3 DIRECTIVES FOR FURTHER RESEARCH . 129 -- EFERENCES . 131 -- APPENDICES 148 -- APPENDIX 1. THE QUESTIONNAIRE 148 -- APPENDIX 1.1. DUTCH QUESTIONNAIRE 148 -- APPENDIX 1.2. FRENCH QUESTIONNAIRE . 163 -- APPENDIX 2. TEMPLATE USED TO ANALYSE THE QUALITATIVE DATA COLLECTED WITH -- THE QUESTIONNAIRE 178 -- APPENDIX 3. TOPICS INVESTIGATED DURING THE QUALITATIVE FOLLOW-UP STUDY 179 -- APPENDIX 4. ADDITIONAL QUANTITATIVE DATA AND ANALYSES . 185 -- APPENDIX 5. CHARACTERISTICS OF RESPONDENTS INVOLVED IN THE QUALITATIVE FOLLOW-UP STUDY 200 Link for e-copy: https://doi.org/10.57598/R296C Format of e-copy: PDF (1,75 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4344

Assessing the management of hospital surge capacity in the first wave of the COVID-19 pandemic in Belgium / Carine Van de Voorde / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2020)  

Assessing the management of hospital surge capacity in the first wave of the COVID-19 pandemic in Belgium [printed text] / Carine Van de Voorde, Author ; Mélanie Lefevre , Author ; Patriek Mistiaen , Author ; Jens Detollenaere , Author ; Laurence Kohn , Author ; Koen Van Den Heede , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2020 . - 309 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 335C) . ISSN : D/2020/10.273/35 : € 0,00 Languages : English (eng) Descriptors: Indexation Critical Illness ; Health Workforce ; Hospital Bed Capacity Classification WX 185 Safety management Link for e-copy: https://doi.org/10.57598/R335C Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4942

Assessing the management of hospital surge capacity in the first wave of the COVID-19 pandemic in Belgium / Carine Van de Voorde / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2020)  

Assessing the management of hospital surge capacity in the first wave of the COVID-19 pandemic in Belgium : Short report [printed text] / Carine Van de Voorde, Author ; Mélanie Lefevre , Author ; Patriek Mistiaen , Author ; Jens Detollenaere , Author ; Laurence Kohn , Author ; Koen Van Den Heede , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2020 . - 76 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 335CS) . ISSN : D/2020/10.273/34 : € 0,00 Languages : English (eng) Descriptors: Indexation Critical Illness ; Health Workforce ; Hospital Bed Capacity Classification WX 185 Safety management Link for e-copy: https://doi.org/10.57598/R335CS Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4943

Assessment and support of decisional capacity in persons with dementia or mental health problems / Imgard Vinck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

Assessment and support of decisional capacity in persons with dementia or mental health problems [printed text] / Imgard Vinck , Author ; Nadia Benahmed, Author ; Marie Dauvrin , Author ; Anja Desomer, Author ; Justien Cornelis , Author ; Pascale Jonckheer , Author ; Patriek Mistiaen , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2022 . - 329 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 349C) . ISSN : D/2021/10.273/55 : € 0,00 Languages : English (eng) Descriptors: Classification W 85 Patients. Attitude and compliance. Satisfaction Indexation 2018-11 ; Decision Making ; Decision Making, Shared ; Dementia ; Mental Competency ; Patient Rights ; R349 Contents note: 1 INTRODUCTION 13 -- 2 SCOPE OF THE STUDY 15 -- 3 RESEARCH QUESTIONS 17 -- 3.1 RESEARCH QUESTION 1: WHAT ARE THE DIFFERENT APPROACHES TOWARDS DECISIONAL CAPACITY, ITS ASSESSMENT AND SUPPORT? 17 -- 3.2 RESEARCH QUESTION 2: HOW DOES BELGIAN LEGISLATION DEAL WITH DECISIONAL CAPACITY AND ITS ASSESSMENT AND SUPPORT? 17 -- 3.3 RESEARCH QUESTION 3: WHAT ARE THE NEEDS OF (HEALTH)CARE PROFESSIONALS (IN THE DOMAIN OF DEMENTIA OR MENTAL HEALTH PROBLEMS) IN THE ASSESSMENT AND SUPPORT OF DECISIONAL CAPACITY? 18 -- 3.4 RESEARCH QUESTION 4: WHAT ARE THE NEEDS OF THE PERSONS WITH MENTAL HEALTH PROBLEMS OR DEMENTIA IN THE ASSESSMENT AND SUPPORT OF DECISIONAL CAPACITY? 18 -- 4 METHODOLOGY 18 -- 5 DECISIONAL CAPACITY IN SCIENTIFIC LITERATURE 19 -- 5.1 OBJECTIVE 19 -- 5.2 METHODOLOGY 19 -- 5.2.1 Search strategy 19 -- 5.2.2 Selection criteria for in- or exclusion 19 -- 5.2.3 Data to retrieve / analysis 21 -- 5.3 RESULTS 22 -- 5.3.1 Description of the included articles. 22 -- 5.3.2 Presentation of the findings 22 -- 5.4 PART 1 - TERMINOLOGY 22 -- 5.4.1 Decision-making : a complex phenomenon 22 -- 5.4.2 Decision-making in the medical context 23 -- 5.4.3 Different wordings and four elements 23 -- 5.4.4 Decisional capacity: decision and time specific 30 -- 5.5 PART 2 - PATHOLOGIES AS SOURCE OF DECISIONAL CAPACITY IMPAIRMENT 32 -- 5.5.1 Dementia 33 -- 5.5.2 Brain tumors and other neurological cancers 33 -- 5.5.3 Schizophrenia spectrum and other psychotic disorders 34 -- 5.5.4 Bipolar and related disorders 35 -- 5.5.5 Depression 35 -- 5.5.6 Autism spectrum disorders 36 -- 5.6 PART 3 - ASSESSING DECISIONAL CAPACITY 37 -- 5.6.1 When is a formal assessment needed? 37 -- 5.6.2 How can an assessment be performed? 41 -- 5.6.3 Who should be designed to be assessor? 51 -- 5.6.4 Which barriers are linked to this assessment? 52 -- 5.6.5 Which facilitators are linked to this assessment? 57 -- 5.6.6 Which recommendations have already been formulated regarding decisional capacity assessment? 65 -- 5.7 PART 4 – IMPACT OF DECISIONAL INCAPACITY: AN ETHICAL QUESTION 69 -- 5.7.1 Discrimination and preconceptions 70 -- 5.7.2 Autonomy versus Paternalism 71 -- 5.7.3 Strategies for improving or maintaining the “decisional capacity” 72 -- 5.8 PART 5 – SUPPORTED DECISION-MAKING PATHWAY 73 -- 5.8.1 Concept 74 -- 5.8.2 When has a supported decision-making pathway to be proposed ? 74 -- 5.8.3 How can a supported decision-making pathway be organized? 75 -- 5.8.4 Who has to be involved in a supported decision-making pathway? 78 -- 5.8.5 Which benefits are described with a supported decision-making pathway? 79 -- 5.8.6 Which barriers are linked to the supported decision-making pathway? 79 -- 5.8.7 Which facilitators are linked to the supported decision-making pathway 82 -- 5.8.8 Which recommendations have already been formulated regarding supported decisionmaking pathway? 84 -- 5.9 PART 6 – ADVANCE DECISION 89 -- 5.9.1 Concepts 89 -- 5.9.2 When should advance decision be proposed? 90 -- 5.9.3 How is advance decision elaborated? 92 -- 5.9.4 Who has to be involved in advance decision pathway? 93 -- 5.9.5 Which benefits are described with advance decision? 95 -- 5.9.6 Which barriers are linked to the advance decision pathway? 97 -- 5.9.7 Which facilitators are linked to the advance decision pathway? 103 -- 5.9.8 Which recommendations have already been formulated regarding advance decision? 107 -- 5.10 PART 7 – SURROGATE DECISION-MAKING PATHWAY: SUBSTITUTED JUDGEMENT AND BEST-INTEREST APPROACH 111 -- 5.10.1 Concepts 111 -- 5.10.2 When a surrogate decision-making pathway should be proposed? 112 -- 5.10.3 How is a surrogate decision-making pathway organized? 113 -- 5.10.4 Who has to be involved in the surrogate decision-making pathway? 116 -- 5.10.5 Which barriers are linked to the surrogate decision-making pathway?. 117 -- 5.10.6 Which facilitators are linked to the surrogate decision-making pathway? 122 -- 5.10.7 Which recommendations have already been formulated regarding surrogate decisionmaking pathway. 125 -- 5.11 LIMITATIONS OF THIS LITERATURE REVIEW 129 -- 5.12 FUTURE RESEARCH 130 -- 5.12.1 Assessment 130 -- 5.12.2 Supported decision-making 131 -- 5.12.3 Advance decision 131 -- 5.12.4 Surrogate decision-making 131 -- 5.12.5 HCPs Training and support 131 -- 6 DECISIONAL CAPACITY AND THE LAW 132 -- 6.1 OBJECTIVE 132 -- 6.2 METHODOLOGY 132 -- 6.3 PART 1 - DECISIONAL CAPACITY: TERMINOLOGY, INTERPRETATION AND ASSESSMENT 133 -- 6.3.1 Terminology 133 -- 6.3.2 The capabilities required to have decisional capacity 134 -- 6.3.3 The assessment of decisional capacity 138 -- 6.4 PART 2 - CONSEQUENCES OF DECISIONAL INCAPACITY: SUBSTITUTE DECISIONMAKING IN THE EXERCISE OF PATIENT’S RIGHTS 149 -- 6.4.1 Who is the substitute decision-maker in charge of exercising patient’s rights? 150 -- 6.4.2 How should a substitute decision-maker decide when exercising patient’s rights? 155 -- 6.4.3 The value of action through which an incapacitated patient appears to oppose treatment. 156 -- 6.4.4 Support in case of reduced decisional capacity? 157 -- 6.5 PART 3 –DECISIONAL CAPACITY IN SPECIFIC LEGISLATION: THE EXAMPLES OF EUTHANASIA, ORGAN DONATION AND MEDICAL EXPERIMENTS 160 -- 6.5.1 Decisional capacity and euthanasia 161 -- 6.5.2 Decisional capacity and experiments on human beings 166 -- 6.5.3 Decisional capacity and organ donation 168 -- 6.6 PART 4 - ADVANCE CARE PLANNING 171 -- 6.6.1 Types of written advance directives 172 -- 6.6.2 Crisis planning for patients with a psychiatric disorder 176 -- 6.7 PART 5 - ADMISSION OF A CARE USER IN A RESIDENTIAL CARE SETTING 178 -- 6.7.1 Admission to a residential care centre (or home replacement environment) 178 -- 6.7.2 Admission in a psychiatric facility 179 -- 6.7.3 Decisional incapacity and day-to-day decisions in a residential care context 183 -- 6.8 PART 6 - THE ROLE OF THE UNITED NATIONS CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES 185 -- 6.9 LIMITATIONS 194 -- 7 PROFESSIONALS’ PERCEPTIONS RELATED TO DECISIONAL CAPACITY 195 -- 7.1 OBJECTIVE 195 -- 7.2 METHODOLOGY 195 -- 7.2.1 Participants 195 -- 7.2.2 Data collection 196 -- 7.2.3 Data analysis 198 -- 7.3 PART 1 -TERMINOLOGY USED BY PROFESSIONALS AROUND DECISIONAL CAPACITY 199 -- 7.3.1 Many synonyms/terms are used 199 -- 7.4 PART 2 - CONTENT AND CHARACTERISTICS OF DECISIONAL CAPACITY 201 -- 7.4.1 Composing elements of decisional capacity 201 -- 7.4.2 Decisional capacity, a ‘relative’ concept 202 -- 7.4.3 Decisional capacity is task/context-specific 202 -- 7.5 PART 3 - ASSESSMENT OF DECISIONAL CAPACITY: CHARACTERISTICS, BARRIERS AND FACILITATORS, METHODS AND CONTEXT 203 -- 7.5.1 Focus on the decision-making process, not on the ultimate decision 203 -- 7.5.2 Standards and modalities for assessment depend on the severity of the pathology and the consequences of the decision for the patient’s health 207 -- 7.5.3 Methods for assessing the decisional capacity 207 -- 7.5.4 When (explicitly) evaluating decisional capacity? 210 -- 7.5.5 Particularities to certain types of mental health problems 210 -- 7.5.6 The impact of the personality and the social context of the patient 211 -- 7.5.7 The (possible) balance of power between the patient and physicians 212 -- 7.5.8 Place of the changing identity/values/preferences 212 -- 7.6 PART 4 - SUPPORTING THE PATIENTS IN THEIR DECISIONAL CAPACITY 214 -- 7.7 PART 5 - NEED FOR GUIDANCE FOR PROFESSIONALS 215 -- 7.8 PART 6 - NEED FOR FEEDBACK TO THE PATIENT 216 -- 7.9 PART 7 - ADVANCE CARE PLANNING 217 -- 7.9.1 Opportunities and limits of advance care planning 217 -- 7.9.2 When initiating advance care planning? 218 -- 7.9.3 Who should initiate/be involved in the process? 219 -- 7.10 PART 8 - CRISIS PLANNING FOR PERSONS WITH PSYCHIATRIC PROBLEMS 221 -- 7.11 LIMITATIONS 221 -- 8 PATIENTS’ PERSPECTIVES ON DECISIONAL CAPACITY 222 -- 8.1 OBJECTIVE 222 -- 8.2 METHODOLOGY 222 -- 8.2.2 Data analysis 225 -- 8.2.3 Ethical aspects 225 -- 8.3 RESULTS 226 -- 8.3.1 Presentation of the participants 226 -- 8.3.2 Presentation of the findings 227 -- 8.4 PART 1 - DECISIONAL CAPACITY AND DECISIONS ABOUT HEALTH CARE 228 -- 8.4.1 Definition/characteristics of the decisional capacity 228 -- 8.4.2 Factors influencing decisional capacity related to health care 229 -- 8.4.3 Patient reported experiences of exerting their decisional capacity 239 -- 8.5 PART 2 - EVALUATION OF THE (IN)CAPACITY 245 -- 8.5.1 Methods to assess the capacity of the patients 245 -- 8.5.2 When should the decisional capacity be assessed? 246 -- 8.5.3 Actors of the evaluation 248 -- 8.5.4 Communication of the results of the evaluation 249 -- 8.5.5 Consequences of the evaluation 249 -- 8.6 PART 3 - SOLUTIONS TO RESTORE AND MAINTAIN DECISIONAL CAPACITY 250 -- 8.6.1 At patient level 250 -- 8.6.2 At institutional level 255 -- 8.6.3 At political level 256 -- 8.7 LIMITATIONS OF THE ANALYSIS AND POTENTIAL BIAS 258 -- 9 DISCUSSION AND CONCLUSIONS 260 -- 9.1 NO CLARITY IN TERMINOLOGY AND DEFINITION OF DECISIONAL CAPACITY 260 -- 9.2 SHIFT FROM SUBSTITUTED-DECISION MAKING TO SUPPORTED-DECISION MAKING? 262 -- 9.3 TOWARDS A MORE PROMINENT ROLE FOR SUPPORTED DECISION-MAKING IN BELGIUM? 264 -- 9.4 ELEMENTS TO STRENGTHEN SUPPORTED DECISION – MAKING 265 -- 9.4.1 Foresee more (types of) support 265 -- 9.4.2 Provide training for patients and support persons 267 -- 9.4.3 Provide training for professionals 268 -- 9.4.4 Manage medical barriers for decisional capacity 268 -- 9.4.5 Facilitate advance care planning 269 -- 9.5 ELEMENTS TO FACILITATE DECISIONAL CAPACITY ASSESSMENTS 272 -- 9.5.1 Guidance on how to deal with decisional capacity (assessments) for healthcare professionals 273 -- 9.5.2 Provide support in the assessment process 275 -- 9.5.3 Provide training, intervision and supervision for professionals 275 -- 9.6 ORGANISING SUBSTITUTE DECISION-MAKING OF PATIENTS IN A COHERENT WAY 276 -- 9.7 FORESEE GUARANTEES RELATED TO COERCION AND OPPOSITION OF PATIENTS 277 -- 9.8 OVERALL NEED FOR SUPPORT MEASURES EMBEDDED IN AN ORGANIZATIONAL AND LEGAL FRAMEWORK TO OPTIMIZE THE PROCESS OF ASSESSING, SUPPORTING AND RESTORING DECISIONAL CAPACITY 278 -- APPENDICES 279 -- APPENDIX 1. LITERATURE SEARCH STRATEGIES 279 -- APPENDIX 1.1. SEARCH STRATEGY 279 -- APPENDIX 1.2. REASONS OF EXCLUSION OF 13 ARTICLES 281 -- APPENDIX 1.3. SUCCINCT DESCRIPTION OF THE 76 INCLUDED ARTICLES 283 -- APPENDIX 1.4. INSTRUMENTS FOR DECISION-MAKING ASSESSMENT. 294 -- APPENDIX 2. STATEMENTS AND CASES OF THE PROFESSIONAL FORUM 300 -- APPENDIX 3. INTERVIEW GUIDE 308 -- APPENDIX 3.1. INTRODUCTION 308 -- APPENDIX 3.2. QUESTIONNAIRE IN FRENCH 309 -- APPENDIX 3.3. TOPIC GUIDE IN DUTCH 315 -- REFERENCES 324 Link for e-copy: https://doi.org/10.57598/R349C Format of e-copy: PDF (4,04 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4811

De behandeling van chronische wonden met hyperbare zuurstoftherapie / Nadia Benahmed / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2016)  

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Belrai suite of instruments / Anja Desomer / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2016)  

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Benodigde ziekenhuiscapaciteit in 2025 en criteria voor aanbodbeheersing van complexe kankerchirurgie, radiotherapie en materniteit / Carine Van de Voorde / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2017)  

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Capacité hospitalière nécessaire en 2025 et critères de la maîtrise de l’offre pour la chirurgie oncologique complexe, la radiothérapie et la maternité / Carine Van de Voorde / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2017)  

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Comment accroître le recours à la chirurgie de jour en Belgique ? / Roos Leroy / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2017)  

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Comment favoriser le recours à l’aide en cas de consommation problématique d’alcool ? / Patriek Mistiaen / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2015)  

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Competences for the organisation of health care, health promotion, prevention and well being in Belgian prisons / Imgard Vinck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2017)  

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Comprehensive geriatric care in hospitals / Mieke Deschodt / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2015)  

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Comprehensive geriatric care in hospitals / Mieke Deschodt / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2015)  

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Comprehensive geriatric care in hospitals / Mieke Deschodt / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2015)  

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