Tuesday, August 30, 2022

Black and Hispanic Patients Disproportionately Referred for Decisional Capacity Consultations

Medical teams may be more likely to seek an evaluation of a patient’s decision-making capacity if the patient is Black or Hispanic than if the patient is White or Asian, suggests a report in Psychiatric Services.

The findings—based on the review of 181 decisional capacity consultations for patients hospitalized at a tertiary care medical center from 2018 to 2019—revealed “capacity assessments appear subject to bias from the beginning of the process,” wrote William S. Garrett, M.D., M.P.H., of Icahn School of Medicine at Mount Sinai and colleagues.

The analysis by Garrett and colleagues involved a retrospective chart review of patient medical records, which contained demographic information, medical and surgical notes, and consultation-liaison psychiatry notes.

They found that capacity consultation requests were placed disproportionately for Black patients, who represented 43% of capacity consultations but only 18% of total inpatient admissions. Hispanic patients represented 26% of capacity consultations and 21% of admissions. Although White patients represented 53% of inpatient admissions, they represented only 28% of capacity consultations and Asian patients represented 9% of admissions and 3% of capacity consultations.

“When challenges to autonomy occur at such a disproportionate rate, a consulting provider’s introduction of a capacity assessment into a patient’s clinical picture has the potential for harm,” Garrett and colleagues wrote. “It raises questions regarding the patient’s decision-making autonomy and capabilities, with significant implications for the perpetuation and worsening of the patient’s vulnerability in the health care system.”

Of the 181 patients included in this study, 130 received an evaluation from a consultation-liaison psychiatrist, and of these, 95 were determined to have no capacity; the authors found that patient race did not affect the likelihood of a no capacity decision. However, Hispanic patients who received a no capacity decision were about three times as likely as Blacks to not experience a change in hospital treatment.

“These findings reveal the potential biases introduced with both the initial challenge to a patient’s capacity and the subsequent outcomes of the consultation. As such, the balance of risk versus benefit or utility of these consultations in certain populations must be carefully considered,” Garrett and colleagues wrote. “Psychiatrists should acknowledge disparate frequencies and impacts of decisional capacity assessments, which can negatively affect therapeutic relationships among patients, families, and care teams.”

For related information, see the Psychiatric News AlertPatients of Color Disproportionately Subjected to Involuntary Admission to Psychiatric Hospitals.”

(Image: iStock/FG Trade)

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