Decisions decisions: what to do when the decider cannot decide

Background: NHS England (2024) reports that, at any one time, 1 in 4 hospital beds are occupied by a person with dementia, a diagnosis that has implications when considering whether a person can, or cannot, consent to their imaging examination. Should a practitioner continue with a procedure without first gaining valid consent, that practitioner could find themselves exposed to allegations of trespass; however, for consent to be valid, the person giving their consent must have the capacity to do so.

Method: Semi-structured interviews were conducted with N = 18 diagnostic radiographers, all working in the UK. Interviews explored participants’ experiences and understanding of assessing capacity in persons with dementia, as well as decision-making when capacity was determined to be lacking. Data were analysed using thematic analysis to identify patterns and themes within the dataset.

Results: The findings demonstrate that establishing capacity was a source of difficulty for the radiographers interviewed. Determining when it was appropriate to proceed with an examination was an area of particular concern, given the legal ramifications associated with proceeding without valid consent. Participants highlighted the need for clear guidance and checklists to support their decision-making in these situations.

Conclusions: Based on these findings, a checklist titled RAD-CHECK (Spacey et al 2026) was developed to guide the diagnostic imaging workforce in their decision-making when a person’s capacity may be lacking.

References:
NHS England (2024) RightCare dementia scenario. Available at: https://www.england.nhs.uk/long-read/rightcare-dementia-scenario/
Spacey A, Booth L, Bowden S, Miller PK. Exploring diagnostic radiographers' experiences and understandings of informed consent and capacity assessment during general radiography imaging examinations of persons living with dementia: A qualitative interview study of UK practice. Radiography 2026 2;32(2):103309. doi: 10.1016/j.radi.2025.103309.