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Good Question: mobile prompts to assist in interviewing for decisional capacity.

For full, free, backup resources, go to our website Dr Suzanne Conboy-Hill & Dr Elizabeth Scott-Gliba ConboyHillScottGliba 2013

Page 2 Contents Page 3 Before you start Page 4 The interview plan Page 5 Asking the questions Page 6 How did it go the positives? Page 7 How did it go the negatives? Page 8 Your decision Page 9 Hints and tips Page 10 Requirements for decisional capacity Page 11 About and link to website

Page 3 Before you start Put together or have to hand 1. Paper and pen 2. Information about what the person was told of the proposed procedure 3. Your list of headings to prompt your probes 4. A place to sit that lets you share your notes with your interviewee

Page 4 Structuring the interview 1. Relax your interviewee with introductions and purpose whats this about? 2. Let them know youll be writing things down as you go. 3. Set the scene: Were here to talk about a given incident or procedure. 4. Uninterrupted account: a. Tell me everything you remember about b. Its ok if you dont remember 5. DONT INTERRUPT! 6. Structured probes: You said that , tell me a bit more about , try to see it in your minds eye 7. Minding the gaps in consent interviews: I see your doctor mentioned ., tell me a bit about that. 8. Anything else? 9. Build a good ending: what happens next and when.

Page 5 Asking the questions Open non leading questions Where.? What..? When..? Why..? How.? Tell me about. Focused non leading questions You said that.what was that about/how does that work? You mentioned a ., tell me about that, whats it like, what does it do?

Page 6 How did it go the positives? The positives: What was the evidence that 1. the interviewee had a general understanding of the decision? 2. they knew why they needed to make the decision? 3. they understood in general the consequences of making the decision? 4. they understood the consequences of not making the decision? 5. they understood what would happen if they didn't agree to proceed? 6. they understood the information they recalled? 7. they understood about risk - both agreeing and not agreeing to proceed? 8. they were able to weigh up the information they had recalled? For instance, how far did they put the elements of recall together to make the bigger picture? How did they demonstrate these things? Roughly how much of the necessary information did they recall? What was the balance, for you, of really important items recalled and less important items recalled? For instance, did they seem to recall a few very important items or a lot of less critical items?

Page 7 How did it go? The negatives: these make your evidence unsafe How many closed questions were there? How many closed leading questions were there? How many responses came from closed questions? How many responses came from leading questions? How many responses came from closed leading questions? How often did you interrupt the interviewee? How often did you give the interviewee given additional information? How often did you seem to break into a silence?

Page 8 Your decision Recall of important information: little moderate most

Understanding: little moderate most Big picture: little Unsafe: little moderate most moderate most

Page 9 Hints & tips Ask open questions that dont have the answer in them and dont invite a yes no answer: Why What How When Where Avoid Closed Questions- if you can answer Yes or No, its closed: o Was that the anaesthetic? o Did the social worker tell you that? o Can you tell me about ? Leading/misleading questions where you know, or you think you know, the answer. Most closed questions are leading, if not misleading. Upgrading the answer where you substitute a better word. It might be completely wrong and it makes the person feel wrong. Teaching during the interview, it will interfere with your interviewees own account. Alternatives and comparisons Was it bigger/lighter/darker than ? Stopping a leading question, just leave the leading element unsaid: So was that the time when? Did you tell him about..? Was it the one in the..?

Page 10 Requirements for decisional capacity Mental Capacity Act 2005 Does the person have a general understanding of what decision they need to make and why they need to make it? [US: Ability to understand relevant information] Does the person have a general understanding of the likely consequences of making, or not making, this decision? [US: Ability to appreciate the nature of the situation and possible consequences] Is the person able to understand, retain, use and weigh up the information relevant to this decision? [US: Ability to manipulate information rationally] Can the person communicate their decision (by talking, using sign language or any other means)? [US: Ability to communicate a choice]

Page 11 About These pages summarise information on our Good Question website so you can use it on the hop in your day-today work without need for or distraction of a computer. Dr Suzanne Conboy-Hill has been a consultant clinical psychologist for adults with intellectual disabilities since 1988 and modified the cognitive interview for consent after researching it for her Master's degree in forensic psychology. She has assessed a wide range of people for capacity, and trained social workers, carers, doctors, nurses, clinical researchers, and lawyers in the technique since 1999. Her publication list is here and LinkedIn profile here. Dr Elizabeth Scott-Gliba is a clinical psychologist who has specialised in eating disorders, mental health, and intellectual disabilities and trained i n the Good Question technique with Dr Conboy-Hill. She has since provided training to many groups of multi-disciplinary professionals. Her LinkedIn profile is here. These prompts are also published on Ether Books, a mobile app for IOS and Android smartphones.