Psych CASC / OSCE · Old age psychiatry — capacity, guardianship and end of life
Capacity for treatment refusal and goals of care — CASC communication station
MRCPsych/FRANZCP-style CASC: goals-of-care and capacity-sensitive communication with patient (and optionally brief spouse joining).
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Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar jointly reviewing with oncology/palliative care. [1]
Candidate instructions. Explore the patient’s understanding of illness and treatment options. Assess capacity elements with teach-back without turning the station into a hostile cross-examination. Elicit values and fears. Screen briefly for depression, hopelessness, and desire for hastened death. Outline advance care planning (proxy appointment, documenting preferences) as a process. If the spouse joins, validate distress while centring the patient’s voice if capacious. Agree next steps. Do not invent statute section numbers or coerce treatment. [1][2][3]
References5ShowHide
- [1]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [2]Sudore RL, Fried TR Redefining the "planning" in advance care planning: preparing for end-of-life decision making Ann Intern Med, 2010.PMID 20713793
- [3]Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment JAMA, 2008.PMID 18840840
- [4]Block SD Assessing and managing depression in the terminally ill patient Ann Intern Med, 2000.PMID 10651602
- [5]Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer JAMA, 2000.PMID 11147988