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

Introduction: Capacity to consent is a legal and ethical consideration when undertaking medical imaging on those people living with dementia. Capacity refers to an individual’s ability to make informed decisions for themselves and is a necessary requirement for valid consent. Previous research has not provided enough insight into establishing capacity to consent and how to proceed with imaging when capacity is lacking, to properly inform practice or policy. This study aims to explore diagnostic radiographers’ experiences and understandings of gaining valid informed consent during general radiography examinations for persons living with dementia.

Methods: Qualitative design using semi-structured-interviews and thematic analysis. A total of 18 Diagnostic-Radiographers participated. All had experience of providing general medical imaging to persons living with dementia.

Results: Findings identified a lack of accessible and transferable policy guidance and training to support radiographers through consent-seeking and capacity-assessment during general radiography examinations with persons living with dementia. Consequently, radiographers reported a lack of confidence and uncertainty assessing capacity and knowing when to make best-interest decisions or seek informed-consent. Furthermore, pressure from referrers, lack of information on requests and the ability to modify techniques led some radiographers to ‘push boundaries’ and disregard the principles of the Mental-Capacity-Act. Conclusion: Diagnostic radiographers working in general radiography lacked confidence in being able to assess capacity and to know when to seek informed consent or make a best interest decision on behalf of a person living with dementia. Future research eliciting data from persons living with dementia and their carers is needed to further inform policy and practice.

Implications for practice: The evidence-based flowchart (RAD-CHECK) can be used support radiographers through the steps required to assess capacity, gain informed consent or make a best-interest decision for persons living with dementia.