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An evaluation protocol for NIHDI conventions / Philippe Vandenbroeck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2018)  

An evaluation protocol for NIHDI conventions [printed text] / Philippe Vandenbroeck, Author ; Wendy Christiaens , Author ; Marie Dauvrin , Author ; Rachel Wickert, Author ; Kim Becher, Author ; Erik Hendrickx, Author ; Jo Goossens, Author ; Liesbeth Jenné, Author ; Marijke Eyssen , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2018 . - 65 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 299C) . ISSN : D/2018/10.273/21 : € 0,00 Languages : English (eng) Descriptors: Classification WA 525 Health Administration and Organization - General works Indexation 2015-18 ; Ambulatory Care ; Chronic Disease ; Efficiency, Organizational ; Long-Term Care ; Multidisciplinary team (MDT) ; Organizational Innovation ; Patient Care Team ; Quality of Health Care ; R299 ; Rehabilitation Contents note: SCIENTIFIC REPORT 1 -- 1 INTRODUCTION 1 -- 1.1 CONVENTIONS AS A MODEL TO FINANCE/REIMBURSE CARE 1 -- 1.2 CONVENTIONS AS A MODEL TO FINANCE/REIMBURSE CARE 4 -- 1.3 CONVENTIONS AS AN AGREEMENT BETWEEN THE NIHDI AND CARE INSTITUTIONS 4 -- 1.3.1 The role of the Board of Medical Directors and the Insurance Committee 4 -- 1.3.2 Overview of the content of the agreement 6 -- 1.3.3 Duration of conventions .8 -- 1.3.4 Existing measures for quality assurance 8 -- 2 SCOPE 9 -- 2.1 CONVENTIONS ARE USED FOR REHABILITATION AND OTHER HEALTH-RELATED CONDITIONS .9 -- 2.2 CONVENTIONS TRANSFERRED TO THE COMMUNITIES 10 -- 2.3 CONCEPTUAL LEVELS 10 -- 3 RESEARCH OBJECTIVES 11 -- 4 A TYPOLOGY OF CONVENTIONS 11 -- 5 QUALITY EVALUATION IN HEALTH CARE: AN INTERNATIONAL PERSPECTIVE 12 -- 5.1 SHORT DESCRIPTION OF THE COUNTRIES INCLUDED IN THE INTERNATIONAL COMPARISON 12 -- 5.1.1 France 12 -- 5.1.2 Scotland 13 -- 5.1.3 The Netherlands 13 -- 5.2 ASSESSMENT OF QUALITY OF HEALTH CARE IN FOUR COUNTRIES: METHODOLOGY 13 -- 5.2.1 Scope of the literature search 13 -- 5.2.2 Search process 14 -- 5.2.3 Analysis 14 -- 5.2.4 Validation by country experts 15 -- 5.3 CROSS-COMPARISON OF THE QUALITY EVALUATION 15 -- 5.4 THE ORGANISATION OF CARE AND FINANCING OF FOUR EXAMPLES OF HEALTH CONDITIONS AND DISEASES 19 -- 5.4.1 In France 19 -- 5.4.2 In Scotland 20 -- 5.4.3 In the Netherlands 21 -- 6 TOWARDS A META-EVALUATION PROTOCOL 22 -- 6.1 APPROACH AND METHODOLOGY 22 -- 6.1.1 A soft systems-inspired approach 22 -- 6.1.2 Operationalisation of the approach 26 -- 6.2 FINDINGS 29 -- 6.2.1 Root definition of a rehabilitation convention 29 -- 6.2.2 VSM-based activity models 30 -- 6.2.3 Measures of performance 34 -- 6.2.4 Perceived strengths and weaknesses of conventions as a financing and operational instrument 34 -- 6.2.5 Perceived weaknesses of conventions contextualised in the VSM-based activity models 41 -- 6.2.6 Reframing of the research question 45 -- 6.3 OUTLINE OF A META-EVALUATION PROTOCOL 47 -- 6.3.1 Preliminary outline of a meta-evaluation protocol 47 -- 6.3.2 Validation in a stakeholder workshop 50 -- 6.3.3 Validation with the Board of Medical Directors 55 -- 6.3.4 Fine-tuning in collaboration with clinical professionals 56 -- 6.3.5 Final version of a meta-evaluation protocol 58 -- REFERENCE LIST 63 Link for e-copy: https://doi.org/10.57598/R299C Format of e-copy: PDF (1,2 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4365

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An evaluation protocol for NIHDI conventions / Philippe Vandenbroeck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2018)  

An evaluation protocol for NIHDI conventions : Supplement [printed text] / Philippe Vandenbroeck, Author ; Wendy Christiaens , Author ; Marie Dauvrin , Author ; Rachel Wickert, Author ; Kim Becher, Author ; Erik Hendrickx, Author ; Jo Goossens, Author ; Liesbeth Jenné, Author ; Marijke Eyssen , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2018 . - 109 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 299S) . ISSN : D/2018/10.273/22 : € 0,00 Languages : English (eng) Descriptors: Classification WA 525 Health Administration and Organization - General works Indexation 2015-18 ; Ambulatory Care ; Chronic Disease ; Efficiency, Organizational ; Long-Term Care ; Multidisciplinary team (MDT) ; Organizational Innovation ; Patient Care Team ; Quality of Health Care ; R299 ; Rehabilitation Contents note: PPENDIX REPORT 1 -- TABLE OF CONTENTS 1 -- LIST OF FIGURES 6 -- LIST OF TABLES 6 -- APPENDIX 1 LIST OF REHABILITATION CONVENTIONS 11 -- APPENDIX 2 DESCRIPTION OF THE QUALITY ASSESSMENT IN BELGIUM, FRANCE, SCOTLAND -- AND THE NETHERLANDS 13 -- APPENDIX 2.1 BELGIUM 13 -- APPENDIX 2.2 FRANCE 16 -- APPENDIX 2.3 SCOTLAND 19 -- APPENDIX 2.4 THE NETHERLANDS 23 -- APPENDIX 3 - THE ORGANISATION OF CARE AND FINANCING OF FOUR EXAMPLES OF HEALTH -- CONDITIONS AND DISEASES 27 -- 1 INTRODUCTION 27 -- 2 FRANCE 27 -- 2.1 DESCRIPTION OF THE FRENCH HEALTH CARE SYSTEM 27 -- 2.1.1 Governance and organisation of the health care system 27 -- 2.1.2 Chronic diseases 28 -- 2.1.3 Rehabilitation and intermediate care 30 -- 2.1.4 Quality and safety monitoring in the health care system 31 -- 2.2 DIABETES 32 -- 2.2.1 Supporting policies and governance 32 -- 2.2.2 Organization and funding of health care 32 -- 2.2.3 Care pathways 33 -- 2.2.4 Health networks 33 -- 2.2.5 Therapeutic education 34 -- 2.2.6 SOPHIA program for improving patient support 34 -- 2.2.7 ASALEE protocol in first line of care 34 -- 2.2.8 Patient participation 35 -- 2.2.9 Evaluation 35 -- 2.3 STROKE 35 -- 2.3.1 Supporting policies and governance 35 -- 2.3.2 Organisation and funding of health care 35 -- 2.3.3 Patient participation 35 -- 2.3.4 Evaluation 36 -- 2.4 HAEMOPHILIA 36 -- 2.4.1 Supporting policies and governance 36 -- 2.4.2 Organisation and funding of health care 36 -- 2.4.3 Patient-level care 38 -- 2.4.4 Patient participation 38 -- 2.4.5 Evaluation 38 -- 2.5 FEMALE GENITAL MUTILATIONS 38 -- 2.5.1 Supporting policies and governance 38 -- 2.5.2 Organisation and funding of health care 39 -- 2.5.3 Patient participation 39 -- 2.5.4 Evaluation 39 -- 2.6 SUMMARY TABLE 39 -- 3 SCOTLAND 40 -- 3.1 DESCRIPTION OF THE SCOTTISH HEALTH CARE SYSTEM 40 -- 3.1.1 Organisation and governance of the health care system 40 -- 3.1.2 Intermediate care sector 41 -- 3.1.3 Patient participation 42 -- 3.1.4 Quality objectives 42 -- 3.2 DIABETES 43 -- 3.2.1 Supporting policies and governance 43 -- 3.2.2 Organisation and funding of health care 43 -- 3.2.3 Patient-level care 44 -- 3.2.4 Patient participation 44 -- 3.2.5 Evaluation 44 -- 3.3 STROKE 45 -- 3.3.1 Supporting policies and governance 45 -- 3.3.2 Organisation and funding of health care 45 -- 3.3.3 Patient level of care 46 -- 3.3.4 Patient participation 49 -- 3.3.5 Evaluation 49 -- 3.4 HAEMOPHILIA 49 -- 3.4.1 Supporting policies and governance 49 -- 3.4.2 Organisation and funding of health care 50 -- 3.4.3 Patient participation 51 -- 3.4.4 Evaluation of the system 51 -- 3.5 FEMALE GENITAL MUTILATION 51 -- 3.5.1 Supporting policies and governance 51 -- 3.5.2 Organisation and funding of health care 52 -- 3.5.3 Patient participation 52 -- 3.5.4 Evaluation of the system 52 -- 3.6 SUMMARY TABLE 53 -- 4 THE NETHERLANDS 54 -- 4.1 DESCRIPTION OF THE DUTCH HEALTH CARE SYSTEM 54 -- 4.1.1 Dutch health care policy and financing 54 -- 4.1.2 Curative care 54 -- 4.1.3 Long-term care 55 -- 4.1.4 Dutch health care organization 56 -- 4.2 DIABETES IN THE NETHERLANDS 59 -- 4.2.1 Supporting policies and governance 59 -- 4.2.2 Organization and funding of health care 60 -- 4.2.3 Evaluation 61 -- 4.3 STROKE/CVA/CARDIOVASCULAR DISEASES AND RISK MANAGEMENT 62 -- 4.3.1 Organization and funding of health care 62 -- 4.3.2 Patient participation 65 -- 4.3.3 Evaluation 65 -- 4.4 HEMOPHILIA 65 -- 4.4.1 Supporting policies and governance 65 -- 4.4.2 Organization and funding of health care 66 -- 4.4.3 Evaluation 66 -- 4.5 FEMALE GENITAL MUTILATION 67 -- 4.5.1 Supporting policies and governance 67 -- 4.5.2 Notification code domestic violence (Meldcode intrafamiliaal geweld) 67 -- 4.5.3 Prevention FGM 67 -- 4.5.4 Example protocol medical care after FGM 67 -- 4.6 SUMMARY TABLE 68 -- 5 CROSS COMPARISON 69 -- 5.1 GENERAL COMMENTS 69 -- 5.1.1 Provision of a setting for the organization and provision of multidisciplinary rehabilitation and care 69 -- 5.1.2 Provision of space for innovative, future-oriented practices 69 -- 5.1.3 Simulation of specialization, concentration of expertise and networking 69 -- 5.1.4 Enhancing ease of financing 70 -- 5.1.5 Provision of low-threshold and affordable care to patients 70 -- 5.1.6 Factors supporting the development of ad hoc rehabilitation programs 70 -- 5.2 SUMMARY TABLE 71 -- APPENDIX 4 LIST OF PARTICIPANTS TO STAKEHOLDER WORKSHOP 75 -- APPENDIX 5 SUMMARY PRESENTATION USED AT THE STAKEHOLDER WORKSHOP 76 -- APPENDIX 6 COMMENTS TO A PRELIMINARY VERSION OF THE META-EVALUATION -- INSTRUMENT BY A REPRESENTATIVE OF A SUBSET OF MULTIDISCIPLINARY CARE -- CONVENTIONS 94 -- APPENDIX 6.1 FINE-TUNING IN COLLABORATION WITH A REPRESENTATIVE OF THE SUBSET OF ‘MULTIDISCIPLINARY CARE’ CONVENTIONS 94 -- REFERENCES 101 Link for e-copy: https://doi.org/10.57598/R299S Format of e-copy: PDF (4 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4366

Animation techniques for better patient involvement / Marie Dauvrin / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2021)  

Animation techniques for better patient involvement : Patient involvement - KCE process book [printed text] / Marie Dauvrin , Author ; Laurence Kohn , Author ; Irina Cleemput , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2021 . - 39 p. : ill., ; A4. ISSN : D/2020/10.2733/25 : € 0,00 Languages : English (eng) Descriptors: Indexation Methods ; Patient Participation Classification W 49 Handbooks. Resource guides Link for e-copy: https://doi.org/10.57598/R340 Format of e-copy: PDF (1,02 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4757

Asielzoekers / Marie Dauvrin / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2019)  

Asielzoekers : pties voor een meer gelijke toegang tot gezondheidszorg. Een stakeholderbevraging [printed text] / Marie Dauvrin , Author ; Jens Detollenaere , Author ; Chris De Laet , Author ; Dominique Roberfroid , Author ; Imgard Vinck , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2019 . - 42 p. : ill., ; A4. - (KCE Reports A. Health Services Research (HSR); 319AS) . € 0,00 Languages : Dutch (nla) Descriptors: Indexation 2017-10 ; Delivery of Health Care ; Economics ; Health Policy ; Health Services Administration ; R319 ; Refugees Classification WA 300 Health issues of special population groups Abstract: Elke migrant die op Belgisch grondgebied aankomt en asiel aanvraagt, krijgt voor de duur van de procedure automatisch toegang tot gezondheidszorg. Verschillende Belgische en internationale rapporten wijzen er echter op dat de toegang tot deze zorg niet voor alle asielzoekers gelijk is. Hierdoor schiet België tekort in het naleven van de internationale verdragen die het mee ondertekende. Aan het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) werd gevraagd hoe aan deze situatie kan worden verholpen. De kern van het probleem is dat de financiering van deze gezondheidszorg afhangt van de verblijfplaats van de asielzoeker. Het KCE stelt voor om de zorgtoegang te vereenvoudigen door alles in één algemene enveloppe onder te brengen. Maar wie zal deze enveloppe beheren? De verschillende opties werden door het KCE bestudeerd, maar het is nu aan de beleidsmakers om een beslissing te nemen. Contents note: 1. INLEIDING 6 -- 1.1. CONTEXT . 6 -- 1.2. ONDERZOEKSVRAGEN . 7 -- 1.3. GEBRUIKTE METHODEN 8 -- 2. HUIDIGE ORGANISATIE VAN DE GEZONDHEIDSZORG VOOR ASIELZOEKERS IN BELGIE 9 -- 2.1. DE PROCEDURE VAN INTERNATIONALE BESCHERMING . 9 -- 2.2. ASIELZOEKERS IN BELGIË 12 -- 2.2.1. Aantal asielzoekers 12 -- 2.2.2. Gezondheidstoestand van asielzoekers .13 -- 2.3. HET OPVANGNETWERK EN DE WIJZE VAN ZORGVERLENING 13 -- 2.3.1. De collectieve opvangcentra .16 -- 2.3.2. De lokale opvanginitiatieven (LOI) .16 -- 2.3.3. Personen met code 207 “No show” 17 -- 2.3.4. Niet-begeleide minderjarige vluchtelingen (NBMV) 17 -- 2.4. WELKE ZORG WORDT GEDEKT? .17 -- 2.5. KOSTEN VAN DE ZORG AAN ASIELZOEKERS .20 -- 3. DE HUIDIGE ORGANISATORISCHE PROBLEMEN, GEMELD DOOR STAKEHOLDERS 21 -- 3.1. MICRONIVEAU 21 -- 3.1.1. Ongelijkheid bij de toegang tot zorg 21 -- 3.1.2. Ongelijke behandeling 23 -- 3.1.3. Ongelijkheid in gezondheidsuitkomsten 24 -- 3.1.4. Overige problemen .24 -- 3.2. MESONIVEAU .24 -- 3.2.1. Systeem niet transparant voor externe zorgverleners .24 -- 3.2.2. Gebrek aan gekwalificeerde zorgverleners voor de specifieke zorg aan asielzoekers 25 -- 3.2.3. Verloop van zorgverleners .25 -- 3.2.4. Weerstand en/of overbelasting van zorgverleners 25 -- 3.2.5. Problemen in de communicatie tussen actoren binnen en tussen opvangplaatsen .26 -- 3.2.6. Gebrek aan passende informatie voor asielzoekers .26 -- 3.3. MACRONIVEAU .26 -- 3.3.1. Gebrek aan coördinatie en samenwerking 26 -- 3.3.2. Gebrek aan opvolging 26 -- 3.3.3. Gebrek aan transparantie over de gezondheidsuitgaven 27 -- 3.3.4. Gebrek aan administratieve ondersteuning 27 -- 3.4. SPECIFIEKE PROBLEMEN BIJ NBMV .27 -- 3.4.1. Tekort aan voogden 27 -- 3.4.2. Moeilijkheden om de voorwaarden voor toegang tot de verplichte ziekteverzekering te respecteren 27 -- 3.4.3. Niet altijd dekking door het ziekenfonds voor NBMV 28 -- 3.5. BIJZONDER PROBLEEM VAN DE GESLOTEN OPVANGCENTRA .28 -- 3.6. BIJZONDER PROBLEEM VAN HET “MEDISCH TOERISME” .28 -- 4. OPTIES OM DE ZORGTOEGANG VOOR ASIELZOEKERS MEER GELIJK TE MAKEN: RESULTAAT VAN DE STAKEHOLDERBEVRAGING .29 -- 4.1. FINANCIERING VAN DE ZORG 30 -- 4.1.1. Optie 1: Het RIZIV financiert en de ziekenfondsen verdelen de financiële middelen = integratie van asielzoekers in de Belgische verplichte ziekteverzekering .30 -- 4.1.2. Optie 2: Fedasil financiert en neemt de rol op van verdeler voor alle asielzoekers .32 -- 4.1.3. Optie 3: De huidige actoren verdelen de financiële middelen, administratie door -- MediPrima en recht op zorg gedekt door de ziekteverzekering 34 -- 4.2. BELEID VAN HET SYSTEEM (‘GOVERNANCE’) 34 -- 4.2.1. Optie 1: Fedasil stuurt de gezondheidszorg voor asielzoekers aan .35 -- 4.2.2. Optie 2: Het beleid van het systeem wordt toevertrouwd aan een strategisch comité 35 -- 4.3. MOGELIJKE VERBETERINGEN AAN HET HUIDIGE SYSTEEM DIE SNEL KUNNEN GEBEUREN (‘QUICK WINS’) 37 -- 4.3.1. ‘Quick wins’ op macroniveau .37 -- 4.3.2. ‘Quick wins’ op OCMW-niveau .38 -- 4.3.3. ‘Quick wins’ op Fedasil-niveau .38 -- 5. CONCLUSIE 39 Link for e-copy: https://doi.org/10.57598/R319AS Format of e-copy: PDF (1,3 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4612

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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

Asylum seekers in Belgium / Marie Dauvrin / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2019)  

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Behoeften en opvolging van patiënten met langdurige COVID / Diego Castanares-Zapatero / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2021)  

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Besoins et suivi des patients atteints de COVID long / Diego Castanares-Zapatero / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2021)  

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Comment améliorer l’accès aux soins de santé des personnes en situation de handicap intellectuel ? / Céline Ricour / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

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Consultations infirmières pour les patients avec des problèmes de santé complexes / Jens Detollenaere / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2023)  

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Demandeurs d’asile / Marie Dauvrin / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2019)  

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Developing an agency's position with respect to patient involvement in health technology assessment / Irina Cleemput in International Journal of Technology Assessment in Health Care, 36(2020)6 ([10/01/2020])  

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Een evaluatieprotocol voor RIZIV conventies / Philippe Vandenbroeck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2018)  

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Evaluatie en ondersteuning van de beslissingsbekwaamheid bij personen met dementie of met geestelijke gezondheidsproblemen / Imgard Vinck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

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Évaluation et soutien de la capacité décisionnelle des personnes atteintes de démence ou de maladie mentale / Imgard Vinck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

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