This workshop explores decision-making capacity within clinical settings, emphasising its dynamic, decision-specific, and time-specific nature. Developed by Vincent Oxenham, Sally Byrne, Heather Francis and Travis Wearne, the session challenges common myths, such as the assumption that poor cognitive screening scores or a diagnosis of dementia automatically imply incapacity.
Drawing on the key principles of capacity (autonomy, dignity and equality), the presentation outlines a structured approach to assessing capacity, including indicators across cognitive domains such as insight, memory, executive functioning, and language. It highlights the continuum of decision-making, from independent to supported to substitute, and advocates for supported decision-making strategies that accommodate cognitive, psychological, and sensory limitations.
The workshop will address complexities of assessing capacity in individuals with neurodegenerative conditions, including variable disease trajectories, fluctuating cognition, and the context-dependent nature of decisions. Accommodations tailored to specific cognitive profiles, such as visual aids for those with intact visual but impaired verbal memory will be discussed.
Cultural dimensions of capacity assessment will also be examined, recognising that Western assessment paradigms may inadequately capture decision-making in diverse contexts. Collective decision-making traditions, the role of family and community elders, and distinguishing culturally valid support from undue influence require careful consideration. For instance, historical context, cultural protocols, language barriers and varying concepts of illness demand accommodation and are fundamental concepts to consider.
The session also explores medico-legal interfaces, including fitness to stand trial. Importantly, these represent separate areas of competency with different cognitive thresholds. For example, an individual may be fit for legal proceedings while lacking capacity for certain medical decisions.
The role of multidisciplinary teams is emphasised, with specific responsibilities for medical teams, allied health professionals and neuropsychologists in identifying risk, facilitating informed choices, and documenting concerns. The process for appointing guardians when substitute decision-making becomes necessary will be detailed. Through practical examples, attendees will gain tools to navigate complex cases ethically, ensuring assessments are person-centred and legally sound.
Overview
This workshop provides a practical and evidence-informed introduction to assessing cognitive and behavioural functioning in adults with neurological conditions. Designed for clinicians working in medical, rehabilitation, and community settings, the session focuses on how neurological disorders affect every day decision-making, functional independence, emotional regulation, and social behaviour. Participants will learn how to apply structured, clinically grounded approaches to capacity assessment, with an emphasis on interpreting cognitive profiles, understanding behavioural change, and integrating findings into person-centred care planning.
Key Topics
Foundations of capacity assessment in adult neurological populations
Cognitive domains essential to decision-making (memory, attention, executive functions, language, social cognition)
Behavioural and emotional changes following stroke, TBI, dementia, or other neurological illnesses
Practical assessment methods including interviewing, behavioural observation, and standardised testing
Integrating cognitive, behavioural, and contextual information into capacity formulations
Communicating results and recommendations clearly within multidisciplinary teams
Culturally responsive and patient-centred considerations in adult assessment
Who Should Attend?
Neuropsychologists, psychologists, psychiatrists, neurologists, rehabilitation physicians, allied health professionals, nurses, and trainees involved in adult neurological assessment and care.
What Participants Will Gain?
A structured framework for evaluating cognitive and behavioural functioning in adult neurological patients
Greater confidence in assessing decision-making abilities and identifying key cognitive contributors
Practical tools for selecting assessment measures and interpreting findings
Strategies for translating assessment outcomes into actionable clinical recommendations
Improved collaboration skills for working with medical teams, families, and rehabilitation providers
Facilitators’ Profile:
Professor Heather Francis, PhD -Macquarie University
Facilitator
Dr Travis Wearne -Macquarie University
Facilitator
Ms Sally Byrne
Facilitator
