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Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do
  1. Dexter Penn1,
  2. Anne Lanceley2,
  3. Aviva Petrie3,
  4. Jacqueline Nicholls4
  1. 1Dementia Research Centre, UCL, London, UK
  2. 2Department of Women’s Cancer, UCL Elizabeth Garrett Anderson Institute for Women’s Health, UCL, London, UK
  3. 3UCL Eastman Dental Institute, UCL, London, UK
  4. 4Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health, UCL, London, UK
  1. Correspondence to Dr Jacqueline Nicholls, Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health, UCL, London, UK; j.nicholls{at}


Background The Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment (MCAx).

Methods This is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.

Results Participants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).

Conclusions This study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.

  • clinical ethics
  • decision-making
  • law
  • health personnel

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  • Correction notice This paper has been updated since first published to update the acknowledgements.

  • Contributors DP and JN conceived and designed the study. AL assisted with questionnaire development and implementation. DP disseminated the questionnaire, prepared the resulting data and conducted statistical analysis. AP advised on statistical analysis and the optimal reporting of results. DP drafted the manuscript, which was amended following comments from all other authors. All authors read and approved the submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was registered with the UCL Data Protection Registration Service (Registration Number): Z6364106/2017/10/110. This project was reviewed by UCL’s Research Ethics Committee (Project ID Number): 10453/002 and was approved as a service evaluation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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