MED-SAIL - NADRC · MED-SAIL was developed by a research team at Baylor College of Medicine (PI - Aanand D. Naik, MD) 2 MED-SAIL Scoring Summary Check completed scenarios below: 1

1

Making & Executing Decisionsfor Safe and Independent Living

MED-SAIL

MED-SAIL Scenarios

and

Scoring Guide

Date of Administration:

Respondent ID:

MED-SAIL was developed by a research team at Baylor College of Medicine (PI - Aanand D. Naik, MD) 1

Table of Contents

MED-SAIL scoring summary.................................................................................................................. 2

General scoring guide.......................................................................................................................... 3

Respondent Instructions and Optional Clinician Script.................................................................... 4

Scenarios ................................................................................................................................................. 5

1. The door to your home is locked and you do not have a key.................................. 5

2. You run out of a medication that you take regularly................................................. 7

3. Imagine you are at home and suddenly there is a fire in your kitchen .................. 9

4. You notice that the cut on your foot is not healing and hasbecome infected................................................................................................................ 11

5. Someone calls you saying you’ve won $100,000 and all they needfrom you is your social security number to verify your identity ............................... 13

6. You are driving to the grocery store and you get a flat tire................................... 15

7. Your heating/air conditioning system breaks down and it is verycold/hot outside ................................................................................................................ 17

Appendix ................................................................................................................................................ 19

Overview of MED-SAIL objective and purpose.................................................................. 20

Instructions for probing............................................................................................................ 21

Domains tested ......................................................................................................................... 22

References ................................................................................................................................. 23


MED-SAIL Scoring Summary

Check completed scenarios below:

1. The door to your home is locked and you do not have a key

2. You run out of a medication that you take regularly

3. Imagine you are at home and suddenly there is a fire in your kitchen

4. You notice that the cut on your foot is not healing and has become infected

5. Someone calls you saying you’ve won $100,000 and all they need fromyou is your social security number to verify your identity

6. You are driving to the grocery store and get a flat tire

7. Your heating unit (air conditioning system) breaks down and it is very cold(hot outside)

Use the score boxes below to record scores for each scenario

In the star-shaped box, record the overall score:

(total points for all scenarios) / (# of scenarios competed x10)

Scenario 1

Total Score: _____ /10

Scenario 2


Scenario 3


Overall Score

_________ /_________

MED-SAIL was developed by a research team at Baylor College of Medicine (PI

MED

1. Please tell me in your own words what I just said.This question is not included in overall score

(Yes) Respondent paraphrases statement, repeats statement, or(No) cannot do either.

2. Would this scenario be a problem for you? Why or why no

(2) Patient answers Yes or No, and explains why or why not(1) Patient answers Yes or(0) No answer; illogical answer

3. What would you do in this scenario?

(2) Respondent suggests remedy(1) Respondent’s response may make sense, but is vague or incomplete(0) Respondent avoids answering the question, even after probing; answer makes no sense

4. What would you do if [respondent’s answerSolving/Consequential Reasoning

(2) Respondent names at least 1 specific consequence that makes sense.(1) Respondent’s response may make sense, but is vague or incomplete(0) Respondent avoids answering the ques

5. So you’ve told me that [respondent’s answer to #3] or that [respondent’s answer to #4].Explain what is good and bad about each of these options.

(2) Respondent names at least 1(1) Respondent’s response may make sense, but is vague; names 1 disadvantage/advantage.(0) Respondent avoids answering the question, even after probing; answer makes no sense

6. A) What could you do to prevent this scenario from happening? OR B) What could you doto prepare for this scenario in case it really happened?Consequences

(2) Respondent names at least 1 specificmakes sense.

(1) Respondent’s response may make sense, but is vague or incomplete(0) Respondent avoids answering the question, even after probing; answer makes no sense

Example respondent answers for each scenario are

provided on the page immediately

score sheet.

Probing does not lower the respondent’s score

SAIL was developed by a research team at Baylor College of Medicine (PI - Aanand D. Naik, MD)

MED-SAIL Scoring Guide

Please tell me in your own words what I just said. UnderstandingThis question is not included in overall score

(Yes) Respondent paraphrases statement, repeats statement, or

Would this scenario be a problem for you? Why or why not? Appreciation

(2) Patient answers Yes or No, and explains why or why notes or No, but has no explanation

(0) No answer; illogical answer

What would you do in this scenario? Expressing a choice

(2) Respondent suggests remedy that makes sense and is specific to respondent’s life.(1) Respondent’s response may make sense, but is vague or incomplete(0) Respondent avoids answering the question, even after probing; answer makes no sense

What would you do if [respondent’s answer to question #3] didn’t work?Solving/Consequential Reasoning

(2) Respondent names at least 1 specific consequence that makes sense.(1) Respondent’s response may make sense, but is vague or incomplete(0) Respondent avoids answering the question, even after probing; answer makes no sense

So you’ve told me that [respondent’s answer to #3] or that [respondent’s answer to #4].Explain what is good and bad about each of these options. Comparative Reasoning

(2) Respondent names at least 1 disadvantage or advantage to each answer (3 and 4).(1) Respondent’s response may make sense, but is vague; names 1 disadvantage/advantage.(0) Respondent avoids answering the question, even after probing; answer makes no sense

A) What could you do to prevent this scenario from happening? OR B) What could you doto prepare for this scenario in case it really happened? Reasoning

(2) Respondent names at least 1 specific A) preventative or B) preparatory mea


Scoring System

•Complete and logical2

•Logical, but incomplete1

•No answer, incomplete, illogical0

Example respondent answers for each scenario are

immediately following each

score sheet.

Probing does not lower the respondent’s score.

3

Appreciation

that makes sense and is specific to respondent’s life.

(0) Respondent avoids answering the question, even after probing; answer makes no sense

to question #3] didn’t work? Problem

(2) Respondent names at least 1 specific consequence that makes sense.

tion, even after probing; answer makes no sense

So you’ve told me that [respondent’s answer to #3] or that [respondent’s answer to #4].Comparative Reasoning

disadvantage or advantage to each answer (3 and 4).(1) Respondent’s response may make sense, but is vague; names 1 disadvantage/advantage.(0) Respondent avoids answering the question, even after probing; answer makes no sense

A) What could you do to prevent this scenario from happening? OR B) What could you doReasoning – Generate

preparatory measure that


Scoring System

Complete and logical

Logical, but incomplete

No answer, incomplete, illogical


Respondent Instructions and Optional Clinician Script

Optional Clinician Scripts

Introductory script:

Questions to determine appropriate scenarios:

1. Do you use a key to get into your home (Scenario #1)

2. Do you drive a car (Scenario #6)

3. Are you able to manage your meals, medications, and phone? (Scenarios #2, 3, 5)

4. Do you take multiple medications on a regular basis? (Scenario #2)

5. Are you diabetic? (Scenarios #2, 4)

Instructions for the Respondent

Select 2-3 of the following scenarios based on what is most appropriate for your respondent:

1. The door to your home is locked and you do not have a key

2. You run out of a medication that you take regularly

3. Imagine you are at home and suddenly there is a fire in your kitchen

4. You notice that the cut on your foot is not healing and has become infected

5. Someone calls you saying you’ve won $100,000 and all they need from you is your socialsecurity number to verify your identity

6. Select scenario if the individual drives – You are driving to the grocery store and you geta flat tire

7. Select scenario depending on whether the individual is more likely to be cold (or hot) –Your heating unit (air conditioning system) breaks down and it is very cold (hot) outside.

Hi, my name is ______, how are you feeling today? I would like to ask you a few questions

about how you do things in your daily life, would that be OK?

I will tell you about a situation. Pretend this is happening to you. Please respond with answersthat are as detailed and specific to you/your life as possible.


Please see other side of this sheet (pg. 6) for

1. Please tell me in your own words what I just said

YesNo

Understands; can repeatCannot repeat statement; does not understand

2. Would getting locked out of your home be a problem for you? Why or why not?

2

1

0

Further probing: What might happen if you didn’t take any action?

3. What would you do if the door to your home was locked and you didn’t have a key?

2

1

0

Further probing: How might you

4. What would you do if [respondent’s answer to question #3] didn’t work?

2

1

0

5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answerto #4]. Explain what is good and bad about each of these options.

2

1

0

Further probing: Is one optionCan you think of one good or bad outcome of each option and compare them?

6. What could you do to prevent yourself from getting locked out of your home?

2

1

0

Further probing: How might this happen in real life?

#1. The door to your home is locked and you do not have a key

Total Score

______ / 10


Please see other side of this sheet (pg. 6) for example scored respondent answers

Please tell me in your own words what I just said


Would getting locked out of your home be a problem for you? Why or why not?What might happen if you didn’t take any action?

What would you do if the door to your home was locked and you didn’t have a key?How might you go about doing that? What are the steps you might take?

What would you do if [respondent’s answer to question #3] didn’t work?

So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answerto #4]. Explain what is good and bad about each of these options.

Is one option better than the other? Why?Can you think of one good or bad outcome of each option and compare them?

What could you do to prevent yourself from getting locked out of your home?How might this happen in real life?


Total Score

______ / 10

Scoring System




5

example scored respondent answers

Would getting locked out of your home be a problem for you? Why or why not?

What would you do if the door to your home was locked and you didn’t have a key?go about doing that? What are the steps you might take?


So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answer

Can you think of one good or bad outcome of each option and compare them?

What could you do to prevent yourself from getting locked out of your home?


Scoring System





Example Scored Respondent Answers


(yes) My door is locked and I don’t have a key

(no) I don’t know; (avoids question, incompliant

2. Would getting locked out of your home be a problem for you? Why or why not?

(2)Yes, this would be a problem for me because I wouldNo, it would not be a problem because my daughter lives next door and she could give me a spare key

(1) Yes/No, this would/wouldn’t be a problem

(0) No, I don’t know; that would never happen to me; (avoids question, incompliant

3. What would you do if the door to your home was locked and you didn’t have a key?

(2)I would call my daughter who could come and let me in; I would call my neighbor who has a spare key; Iwould go get my spare key that I hid under

(1) I would call my daughter

(0) I don’t know; that would never happen to me; (avoids question, incompliant


(2)I would go to my neighbor’swindow so I could get into my house and then I would call someone to fix my window

(1) I would call a locksmith

(0) I don’t know; that would never happen to me; (avoids question,


(2)Going to my neighbor’s house would be easy and quickfree; I might get hurt breaking open a window and it would be expensive to fix, so calling a neighbor orlocksmith would be better

(1) Breaking a window would be bad because it would be expensive to fix

(0) I don’t know; (avoids question, incompliant

6. What could you do to prevent yourself from getting locked out of your home?

(2) I could keep a spare key with my neighbor/daughter and keep their phone number in my wallet/purse

(1) Get a spare key






My door is locked and I don’t have a key

(avoids question, incompliant – even after probing)


Yes, this would be a problem for me because I would need to get into my houseNo, it would not be a problem because my daughter lives next door and she could give me a spare key

Yes/No, this would/wouldn’t be a problem

No, I don’t know; that would never happen to me; (avoids question, incompliant –

What would you do if the door to your home was locked and you didn’t have a key?

I would call my daughter who could come and let me in; I would call my neighbor who has a spare key; Iwould go get my spare key that I hid under the front doormat

I don’t know; that would never happen to me; (avoids question, incompliant – even after probing)


I would go to my neighbor’s house and look up a locksmith’s number and call him; I would break open awindow so I could get into my house and then I would call someone to fix my window



Going to my neighbor’s house would be easy and quick compared to calling a locksmith, plus it would befree; I might get hurt breaking open a window and it would be expensive to fix, so calling a neighbor or

Breaking a window would be bad because it would be expensive to fix



I could keep a spare key with my neighbor/daughter and keep their phone number in my wallet/purse



6


No, it would not be a problem because my daughter lives next door and she could give me a spare key

– even after probing)

What would you do if the door to your home was locked and you didn’t have a key?

I would call my daughter who could come and let me in; I would call my neighbor who has a spare key; I

even after probing)


house and look up a locksmith’s number and call him; I would break open awindow so I could get into my house and then I would call someone to fix my window

even after probing)


compared to calling a locksmith, plus it would befree; I might get hurt breaking open a window and it would be expensive to fix, so calling a neighbor or


I could keep a spare key with my neighbor/daughter and keep their phone number in my wallet/purse

even after probing)



Please see other side of this sheet (pg.


YesNo


2. Would running out of a medication you take regularly

2

1

0


3. What would you do if you ran out of a

2

1

0

Further probing: How might you go about doing that? What are the steps you might take?


2

1

0

5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’sanswer to #4]. Explain what is good and bad about each of these options.

2

1

0

Further probing: Is one optionCan you think of one good or bad outcome of each option and compare them?

6. What could you do to prevent yourself from running out of a medication you take regularly

2

1

0


#2. You run out of a medication that you take regularly

Total Score

______ / 10





running out of a medication you take regularly be a problem for you? Why or why not?What might happen if you didn’t take any action?

you ran out of a medication that you take regularlyHow might you go about doing that? What are the steps you might take?


[respondent’s answer to question #3] or that [respondent’sanswer to #4]. Explain what is good and bad about each of these options.


prevent yourself from running out of a medication you take regularlyHow might this happen in real life?


Total Score

______ / 10

Scoring System




7

) for example scored respondent answers

be a problem for you? Why or why not?

medication that you take regularly?How might you go about doing that? What are the steps you might take?


[respondent’s answer to question #3] or that [respondent’sanswer to #4]. Explain what is good and bad about each of these options.


prevent yourself from running out of a medication you take regularly?


Scoring System





Example Scored


(yes)I’ve run out of my heart medication; I’ve run out of my blue pills that I take every day; I’ve run out of amedication; I’ve run out of a medication that I take regularly


2. Would running out of a medication you take regularlywhy not?

(2)Yes, this would be a problem for me because I need my heart medication to keep myself fromheart attack; I need my insulin to keep my blood sugar low so I don’t pass out or get sick



3. What would you do if you ran out of a medication you take regularly

(2)Call my doctor who would then give me a refill; call in my refill at the pharmacy and go pick it up; ask mydaughter (caregiver) who would refill my medication

(1) I would call my doctor; I would call my daughter



(2)I would go to urgent care to get another prescription and fill it at a 24daughter and tell her I needed help getting my medicine right away

(1) I would call my doctor; I would call my daughter; I would go get my


5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’sanswer to #4]. Explain what is good and bad about each of

(2)Going to urgent care would be bad because it would require a long wait compared to having my doctor callin a refill which would be faster; having my daughter take care of it would be the fastest and easiest way forme to take care of things

(1) I would wait a long time at urgent care


6. What could you do to prevent yourself fromregularly?

(2)I could keep track of when my pillsnotice my pills are almost gone; I could ask my daughter (caregiver) to keep track of my medication

(1) I could keep track of my pills; I could talk to my doctor





Please tell me in your own words what I just saidI’ve run out of my heart medication; I’ve run out of my blue pills that I take every day; I’ve run out of amedication; I’ve run out of a medication that I take regularly


running out of a medication you take regularly be a problem for you? Why or

Yes, this would be a problem for me because I need my heart medication to keep myself fromheart attack; I need my insulin to keep my blood sugar low so I don’t pass out or get sick



do if you ran out of a medication you take regularly

Call my doctor who would then give me a refill; call in my refill at the pharmacy and go pick it up; ask mydaughter (caregiver) who would refill my medication

I would call my daughter; I would go get my medication



I would go to urgent care to get another prescription and fill it at a 24-hour pharmacy; I would call mydaughter and tell her I needed help getting my medicine right away

I would call my doctor; I would call my daughter; I would go get my medication


So you’ve told me that [respondent’s answer to question #3] or that [respondent’sanswer to #4]. Explain what is good and bad about each of these options.

Going to urgent care would be bad because it would require a long wait compared to having my doctor callin a refill which would be faster; having my daughter take care of it would be the fastest and easiest way for

I would wait a long time at urgent care


What could you do to prevent yourself from running out of a medication you take

I could keep track of when my pills will run out so I’ll know when to get a refill; I could call my doctor when Inotice my pills are almost gone; I could ask my daughter (caregiver) to keep track of my medication

I could keep track of my pills; I could talk to my doctor

know; that would never happen to me; (avoids question, incompliant – even after probing)


8

I’ve run out of my heart medication; I’ve run out of my blue pills that I take every day; I’ve run out of a

be a problem for you? Why or

Yes, this would be a problem for me because I need my heart medication to keep myself from having aheart attack; I need my insulin to keep my blood sugar low so I don’t pass out or get sick


do if you ran out of a medication you take regularly?

Call my doctor who would then give me a refill; call in my refill at the pharmacy and go pick it up; ask my

even after probing)


hour pharmacy; I would call my

even after probing)

So you’ve told me that [respondent’s answer to question #3] or that [respondent’sthese options.

Going to urgent care would be bad because it would require a long wait compared to having my doctor callin a refill which would be faster; having my daughter take care of it would be the fastest and easiest way for

running out of a medication you take

will run out so I’ll know when to get a refill; I could call my doctor when Inotice my pills are almost gone; I could ask my daughter (caregiver) to keep track of my medication

even after probing)





YesNo


2. Would being at home with a fire in your kitchen

2

1

0


3. What would you do if you were at home and

2

1

0



2

1

0


2

1

0

Further probing: Is one option better than the other? Why?Can you think of one good or bad outcome of each option and compare them?

6. What could you do to prepare yourself in case a fire really did start in your kitchen

2

1

0


#3. Imagine you are at home and suddenly there is a fire in your kitchen

Total Score

______ / 10





being at home with a fire in your kitchen be a problem for you? Why or why not?What might happen if you didn’t take any action?

you were at home and there was a fire in your kitchenHow might you go about doing that? What are the steps you might take?




prepare yourself in case a fire really did start in your kitchenHow might this happen in real life?

Imagine you are at home and suddenly there is a fire in your kitchen

Total Score

______ / 10

Scoring System




9



there was a fire in your kitchen?How might you go about doing that? What are the steps you might take?




prepare yourself in case a fire really did start in your kitchen?

Imagine you are at home and suddenly there is a fire in your kitchen

Scoring System







(yes) I’m at home and suddenly there’s a fire in my kitchen


2. Would being at home with a fire in your kitchen

(2)Yes, this would be a problem for mehome



3. What would you do if you

(2) I would throw water on the fire and try to put it out; I would get out of the house and call 911

(1) Throw water; put it out; yell for help

(0) I don’t know; that would never happen to me;


(2) I would leave my house immediately and get help from a neighbor; I would leave and call 911

(1) I would call 911



(2)If I just left without trying to put out the fire, my home would probably be destroyed because the fire wouldspread

(1) I would try to put it out so the fire wouldn’t spread


6. What could you do to prepare yourself in case a fire really did start in your kitchen

(2) I could keep a fire extinguisher in my house and put 911 on speed dial

(1) Avoid cooking

(0) I don’t know; that would never happen to me; (avoids question,

#3. Imagine you are at home and suddenly there is a fire in your kitchen




at home and suddenly there’s a fire in my kitchen


being at home with a fire in your kitchen be a problem for you? Why or why not?

Yes, this would be a problem for me because the fire could spread and I could die; the fire could destroy my



you were at home and suddenly there was a fire in your kitchen

I would throw water on the fire and try to put it out; I would get out of the house and call 911

Throw water; put it out; yell for help



I would leave my house immediately and get help from a neighbor; I would leave and call 911

know; that would never happen to me; (avoids question, incompliant – even after probing)


just left without trying to put out the fire, my home would probably be destroyed because the fire would

I would try to put it out so the fire wouldn’t spread


prepare yourself in case a fire really did start in your kitchen

fire extinguisher in my house and put 911 on speed dial


. Imagine you are at home and suddenly there is a fire in your kitchen

10


because the fire could spread and I could die; the fire could destroy my


were at home and suddenly there was a fire in your kitchen?

I would throw water on the fire and try to put it out; I would get out of the house and call 911

even after probing)


I would leave my house immediately and get help from a neighbor; I would leave and call 911

even after probing)


just left without trying to put out the fire, my home would probably be destroyed because the fire would

prepare yourself in case a fire really did start in your kitchen?

even after probing)

. Imagine you are at home and suddenly there is a fire in your kitchen




YesNo


2. Would having an infected cut on your footor why not?

2

1

0

Further probing: What might

3. What would you do if there was an infected cut on your foot that wasn’t healing

2

1

0



2

1

0


2

1

0

Further probing: Is one option better than the other? Why?Can you think of

6. What could you do to prevent yourself from getting2

1

0


#4. You notice that the cut on your foot is not healing and has become

Total Score

______ / 10





having an infected cut on your foot that isn’t healing be a problem for you? Why

What might happen if you didn’t take any action?

there was an infected cut on your foot that wasn’t healingHow might you go about doing that? What are the steps you might take?


So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answeris good and bad about each of these options.


What could you do to prevent yourself from getting cuts on your footHow might this happen in real life?

#4. You notice that the cut on your foot is not healing and has becomeinfected

Total Score

______ / 10

Scoring System




11


be a problem for you? Why

there was an infected cut on your foot that wasn’t healing?How might you go about doing that? What are the steps you might take?



one good or bad outcome of each option and compare them?

cuts on your foot?


Scoring System







(yes) I cut my foot, it isn’t healing, and it has become infected


2. Would having an infected cut on your foot that isn’t healingor why not?

(2) Yes this would be a problem because if my foot got infected, I could get very sick, lose my foot, or even die



3. What would you do if there was an infected cut on your foot that wasn’t healing

(2)I would make an appointment with my doctor so he could help the cut get better; I would call my daughterwho would take me to the doctor

(1) I would call my daughter (caregiver)



(2) I could look up a number for urgent care and get my daughter to

(1) Go to urgent care



(2)My regular doctor would know me and my history, so that would be better than a random doctor in urgentcare, plus I wouldn’t have to wait as long. The bad thing about seeing my regular doctor is that I wouldprobably have to wait a day or two to get an appointment.

(1)Calling my doctor would be better because he knows me; going to urgent care would be better because Icould go the same day


6. What could you do to prevent yourself

(2)I could wear socks and shoes or slippers; I could check myself daily for cuts and put medicine on the cuts Ido have

(1) I could take care of my cuts






cut my foot, it isn’t healing, and it has become infected


having an infected cut on your foot that isn’t healing be a problem for you? Why

problem because if my foot got infected, I could get very sick, lose my foot, or even die



if there was an infected cut on your foot that wasn’t healing

I would make an appointment with my doctor so he could help the cut get better; I would call my daughterwho would take me to the doctor

(caregiver)



I could look up a number for urgent care and get my daughter to take me there


So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answergood and bad about each of these options.

My regular doctor would know me and my history, so that would be better than a random doctor in urgentcare, plus I wouldn’t have to wait as long. The bad thing about seeing my regular doctor is that I wouldprobably have to wait a day or two to get an appointment.

Calling my doctor would be better because he knows me; going to urgent care would be better because I


What could you do to prevent yourself from getting cuts on your footI could wear socks and shoes or slippers; I could check myself daily for cuts and put medicine on the cuts I

that would never happen to me; (avoids question, incompliant – even after probing)

#4. You notice that the cut on your foot is not healing and has becomeinfected

12

be a problem for you? Why

problem because if my foot got infected, I could get very sick, lose my foot, or even die


if there was an infected cut on your foot that wasn’t healing?

I would make an appointment with my doctor so he could help the cut get better; I would call my daughter

even after probing)


even after probing)


My regular doctor would know me and my history, so that would be better than a random doctor in urgentcare, plus I wouldn’t have to wait as long. The bad thing about seeing my regular doctor is that I would

Calling my doctor would be better because he knows me; going to urgent care would be better because I

from getting cuts on your foot?I could wear socks and shoes or slippers; I could check myself daily for cuts and put medicine on the cuts I

even after probing)





YesNo


2. Would someone asking for your socialproblem for you? Why or why not?2

1

0


3. What would you do if someone called saying they needed your social security number foryou to claim prize money2

1

0


4. What would you do if [respondent’s answer to question #3] didn’t work?2

1

0

5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answerto #4]. Explain what is good and bad about each of these options.2

1

0


6. What could you do to prevent2

1

0


#5. Someone calls you saying you've won $100,000 and all they needfrom you is your social security number to verify your identity

Total Score

______ / 10



your own words what I just said


someone asking for your social security number for you to claim prize moneyproblem for you? Why or why not?


if someone called saying they needed your social security number foryou to claim prize money?

How might you go about doing that? What are the steps you might take?




What could you do to prevent yourself from getting calls like this in the futureHow might this happen in real life?

. Someone calls you saying you've won $100,000 and all they needfrom you is your social security number to verify your identity

Total Score

______ / 10

Scoring System




13


security number for you to claim prize money be a

if someone called saying they needed your social security number for

How might you go about doing that? What are the steps you might take?




yourself from getting calls like this in the future?


Scoring System







(yes) I received a phone call from someone saying I’ve won $100,000 and they want my social security


2. Would someone asking for your social security number for you to claim prize moneyproblem for you? Why or why not?

(2) Yes, this would be a problem because it means that a scammer got my phone number



3. What would you do if someone called saying they needed your social security number foryou to claim prize money

(2) I wouldn’t talk to them because it’s probably a scam

(1) Hang up the phone (without any additional rationale or justification)



(2)I would write down the number and I would get caller ID so when they called, I wouldn’t answer; try to get aname or information so I could report them to someone

(1) Hang up again (without any rationale or justification)

(0) I don’t know; that would never happen to me;


(2)It’s easier to just hang up, and I don’tfind out that information, which could take a while

(1) Hanging up the phone would be easiest


6. What could you do to prevent yourself from getting

(2)I could put my name on the “do not call” list; I could be careful about who I give my phone number to; Icould get caller ID and screen my phone calls

(1) Not talk to them


#5. Someone calls you saying you've won $100,000 and all they needfrom you is your social security number to verify your identity




I received a phone call from someone saying I’ve won $100,000 and they want my social security


someone asking for your social security number for you to claim prize money? Why or why not?

Yes, this would be a problem because it means that a scammer got my phone number



someone called saying they needed your social security number foryou to claim prize money?

I wouldn’t talk to them because it’s probably a scam

(without any additional rationale or justification)



number and I would get caller ID so when they called, I wouldn’t answer; try to get aname or information so I could report them to someone

(without any rationale or justification)



It’s easier to just hang up, and I don’t know how to put someone on the “do not call” list, so I would have tofind out that information, which could take a while

Hanging up the phone would be easiest


What could you do to prevent yourself from getting calls like this in the futureput my name on the “do not call” list; I could be careful about who I give my phone number to; I

could get caller ID and screen my phone calls



14

I received a phone call from someone saying I’ve won $100,000 and they want my social security number

someone asking for your social security number for you to claim prize money be a

Yes, this would be a problem because it means that a scammer got my phone number


someone called saying they needed your social security number for

even after probing)


number and I would get caller ID so when they called, I wouldn’t answer; try to get a

even after probing)


know how to put someone on the “do not call” list, so I would have to

calls like this in the future?put my name on the “do not call” list; I could be careful about who I give my phone number to; I

even after probing)





YesNo


2. Would getting a flat tire on the way to the grocery storewhy not?

2

1

0


3. What would you do if you got a flat tire2

1

0


4. What would you do if [respondent’s answer to question #3] didn’t work?2

1

0

5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answerto #4]. Explain what is good and bad about each of these options.2

1

0

Further probing: Is one option better than the other? Why?Can you think of one good or bad outcome of each option and compare them?

6. What could you do to prepare yourself in case you did get a flat tire on the way to thegrocery store?2

1

0


#6. You are driving to the grocery store and you get a flat tire

Total Score

______ / 10





getting a flat tire on the way to the grocery store be a problem for you? Why or


you got a flat tire on the way to the grocery storeHow might you go about doing that? What are the steps you might take?




prepare yourself in case you did get a flat tire on the way to the

How might this happen in real life?


Total Score

______ / 10

Scoring System




15

respondent answers

be a problem for you? Why or

on the way to the grocery store?How might you go about doing that? What are the steps you might take?




prepare yourself in case you did get a flat tire on the way to the


Scoring System







(yes) I’m driving to the grocery store and I get a flat tire


2. Would getting a flat tire on the way to the grocery store be a problem for youwhy not?

(2)Yes this would be a problem for me because I would be stranded for a while, then I would have to find a wayto fix my tire or get a new one



3. What would you do if you got a flat tire on the way to the grocery store

(2) I would call my daughter to come pick me up; I would call AAA so someone could come help me

(1) I would call for help

(0) I don’t know; that would never


(2)I would try to walk somewhere to find help or I would call 411 to see if someone could help me; I wouldchange my flat tire

(1) I would call 911


5. So you’ve told me that [respondent’s answer to question #3] or that [respondent’s answerto #4]. Explain what is good

(2)I might get hurt changing my flat tire or I might not be able to do it, so calling someone to come help mewould be better; calling someone could take a long time, so I would try to fix the tire first

(1) Calling someone would be easier


6. What could you do to prepare yourself in case you did get a flat tire in the future?

(2)I could take the bus so I wouldn’t have to worry about my tires; Iwould need to fix a flat in my car; I could keep a cell phone with AAA’s number in my car so I could call themif I had a flat

(1) I could drive more carefully; I could keep a spare tire






I’m driving to the grocery store and I get a flat tire


a flat tire on the way to the grocery store be a problem for you

problem for me because I would be stranded for a while, then I would have to find a wayto fix my tire or get a new one



you got a flat tire on the way to the grocery store

I would call my daughter to come pick me up; I would call AAA so someone could come help me



I would try to walk somewhere to find help or I would call 411 to see if someone could help me; I would



I might get hurt changing my flat tire or I might not be able to do it, so calling someone to come help mewould be better; calling someone could take a long time, so I would try to fix the tire first

someone would be easier


prepare yourself in case you did get a flat tire in the future?I could take the bus so I wouldn’t have to worry about my tires; I could put a spare tire and all the tools Iwould need to fix a flat in my car; I could keep a cell phone with AAA’s number in my car so I could call them

I could drive more carefully; I could keep a spare tire

would never happen to me; (avoids question, incompliant – even after probing)


16

a flat tire on the way to the grocery store be a problem for you? Why or

problem for me because I would be stranded for a while, then I would have to find a way


you got a flat tire on the way to the grocery store?

I would call my daughter to come pick me up; I would call AAA so someone could come help me

even after probing)


I would try to walk somewhere to find help or I would call 411 to see if someone could help me; I would

even after probing)


I might get hurt changing my flat tire or I might not be able to do it, so calling someone to come help mewould be better; calling someone could take a long time, so I would try to fix the tire first

prepare yourself in case you did get a flat tire in the future?could put a spare tire and all the tools I

would need to fix a flat in my car; I could keep a cell phone with AAA’s number in my car so I could call them

even after probing)





YesNo


2. Would having your heater (AC) break downfor you? Why or why not?

2

1

0


3. What would you do if your heater (AC) broke down and it was very cold (hot) outside

2

1

0



2

1

0


2

1

0


6. What could you do to prepare yourself in case your heater (AC) unit did break down2

1

0


#7. Your heating unit (air conditioning system) breaks down and it is very

Total Score

______ / 10





having your heater (AC) break down during very cold (hot) weatherfor you? Why or why not?


your heater (AC) broke down and it was very cold (hot) outsideHow might you go about doing that? What are the steps you might take?




prepare yourself in case your heater (AC) unit did break downHow might this happen in real life?

#7. Your heating unit (air conditioning system) breaks down and it is verycold (hot) outside

Total Score

______ / 10

Scoring System




17


during very cold (hot) weather be a problem

your heater (AC) broke down and it was very cold (hot) outside?How might you go about doing that? What are the steps you might take?




prepare yourself in case your heater (AC) unit did break down?


Scoring System







(yes) My heater (air conditioner) is broken and it’s cold (hot) outside


2. Would having your heater (AC) break down during very cold (hot) weatherfor you? Why or why not?

(2)Yes, this would be a problem because I could get really cold (hot) and get sick or freeze to death (have aheat stroke)



3. What would you do your heater (AC) broke down and it was very cold (hot) outside

(2) I would call a repair man to come and fix it; I would call my daughter for help

(1) I would call my someone

(0) I don’t know; that would never happen


(2)I would call a different repair man and then see if I could stay at my daughter’s house until it was fixed; Iwould put blankets over the windows and wear lots of clothes (cold); I would turn on a fan and dress in lightclothing (hot)

(1) I would call another repair man



(2)Getting it fixed would be better than using blankets (fans) because it would be a longproblem; asking my daughter to fix it would be the best thing because it would be faster and free comparedto calling a repair man

(1) I would call my daughter because she could get it done


6. What could you do to prepare yourself in case your heater (AC) unit did break down

(2) I could get a space heater (fan) and blankets to be prepared if it ever happened

(1) Find a way to stay warm (cool)

(0) I don’t know; that would never





My heater (air conditioner) is broken and it’s cold (hot) outside


having your heater (AC) break down during very cold (hot) weatherfor you? Why or why not?

Yes, this would be a problem because I could get really cold (hot) and get sick or freeze to death (have a



your heater (AC) broke down and it was very cold (hot) outside

I would call a repair man to come and fix it; I would call my daughter for help


What would you do if [respondent’s answer to question #3] didn’t work?I would call a different repair man and then see if I could stay at my daughter’s house until it was fixed; I

blankets over the windows and wear lots of clothes (cold); I would turn on a fan and dress in light

I would call another repair man



Getting it fixed would be better than using blankets (fans) because it would be a longproblem; asking my daughter to fix it would be the best thing because it would be faster and free compared

I would call my daughter because she could get it done


prepare yourself in case your heater (AC) unit did break down

I could get a space heater (fan) and blankets to be prepared if it ever happened

Find a way to stay warm (cool)


#7. Your heating unit (air conditioning system) breaks down and it is verycold (hot) outside

18

having your heater (AC) break down during very cold (hot) weather be a problem

Yes, this would be a problem because I could get really cold (hot) and get sick or freeze to death (have a


your heater (AC) broke down and it was very cold (hot) outside?

even after probing)

What would you do if [respondent’s answer to question #3] didn’t work?I would call a different repair man and then see if I could stay at my daughter’s house until it was fixed; I

blankets over the windows and wear lots of clothes (cold); I would turn on a fan and dress in light

even after probing)


Getting it fixed would be better than using blankets (fans) because it would be a long-term fix to theproblem; asking my daughter to fix it would be the best thing because it would be faster and free compared

prepare yourself in case your heater (AC) unit did break down?

even after probing)



Appendix


1. MED-SAIL is used to evaluate decisionthese pertain to situations arising

MED-SAIL offers information that other assessments do not

Most assessments measure cognitive functioning in strict domains

o Short-term memory

o Spatial orientation

MED-SAIL evaluates multiple domains within the context of realo Decision-making capacity

o Problem solving

o Judgment

MED-SAIL provides practical information for clinical tasks

o Identifying specific safety problems in respondent’s life

o Writing guardianship letters

2. Respondents do not lose points for “bad” answers that

Evaluation of capacity to make and modify decisions

Appropriate respondent answers are not necessarily knowledge

Example:o Clinician question: “What would you do if you ran out of medication?”o Respondent answer: “Take my h

o Respondent further explanation: “I always do this with little side effects” or “it’s the exact

same medication, so it doesn’t matter”

o These are appropriate responses because decision

It is within a respondent’s righ

3. MED-SAIL is not a diagnostic tool, but rather a screening tool designed to be used with other

assessments

The purpose of MED-SAIL is to learn about the respondent’s thought processo Further diagnostic

o MED-SAIL is not meant to be used as a tool to diagnose mental health problems, such as

dementia or schizophrenia

MED-SAIL may identify gaps in specific domains of safety

o More assessment is neededo Use MED-SAIL with other assessments to provide more thorough understanding of

respondent’s ability to live safely and independently

MED-SAIL is NOT meant to be used in isolation to determine a respondent’s status or

Objective: Screen for and identify impairments in a respondent’s ability to make andexecute decisions concerning safe and independent living using everyday scenarios

research team at Baylor College of Medicine (PI - Aanand D. Naik, MD)

MED-SAIL Overview

SAIL is used to evaluate decision-making capacity, problem solving, and judgment asthese pertain to situations arising in everyday living

SAIL offers information that other assessments do not

Most assessments measure cognitive functioning in strict domains

term memory

Spatial orientation

SAIL evaluates multiple domains within the context of real-life situatiomaking capacity

SAIL provides practical information for clinical tasks

Identifying specific safety problems in respondent’s life

Writing guardianship letters

Respondents do not lose points for “bad” answers that are appropriately explained

Evaluation of capacity to make and modify decisions

Appropriate respondent answers are not necessarily knowledge-based

Clinician question: “What would you do if you ran out of medication?”Respondent answer: “Take my husband’s pills”

Respondent further explanation: “I always do this with little side effects” or “it’s the exact

same medication, so it doesn’t matter”

These are appropriate responses because decision-making ability is intact

It is within a respondent’s rights to make decisions with which you do not agree

SAIL is not a diagnostic tool, but rather a screening tool designed to be used with other

SAIL is to learn about the respondent’s thought processFurther diagnostic evaluation needed for those having trouble making decisions

SAIL is not meant to be used as a tool to diagnose mental health problems, such as

dementia or schizophrenia

SAIL may identify gaps in specific domains of safety

More assessment is needed to determine a proper intervention planSAIL with other assessments to provide more thorough understanding of

respondent’s ability to live safely and independently

SAIL is NOT meant to be used in isolation to determine a respondent’s status or

Screen for and identify impairments in a respondent’s ability to make andexecute decisions concerning safe and independent living using everyday scenarios

20

making capacity, problem solving, and judgment as

life situations

are appropriately explained

Clinician question: “What would you do if you ran out of medication?”

Respondent further explanation: “I always do this with little side effects” or “it’s the exact

making ability is intact

ts to make decisions with which you do not agree

SAIL is not a diagnostic tool, but rather a screening tool designed to be used with other

SAIL is to learn about the respondent’s thought processevaluation needed for those having trouble making decisions

SAIL is not meant to be used as a tool to diagnose mental health problems, such as

to determine a proper intervention planSAIL with other assessments to provide more thorough understanding of

SAIL is NOT meant to be used in isolation to determine a respondent’s status or capacity level

Screen for and identify impairments in a respondent’s ability to make andexecute decisions concerning safe and independent living using everyday scenarios


Why Probe?Most assessments have directions that must be followed precisely, which means the administrator cannot

offer further help or clarification to the respondent. MED

be encouraged to give the most complete answ

record the respondent’s thought process. See specific instructions below.

Probing Instructions for the MED

If the respondent gives a vague answer without specific details:o Continue probing (see example phrases below) to encourage further elaboration

Ask another question

Rephrase the same question

o Avoid asking questions that would lead the respondent to a particular answer or to a“yes” or “no” response

If the respondent still does not

o Continue further probing in the same mannero Probing and providing more details to your questions in encouragedo Continue until it is clear that the respondent’s answer will not change significantly

If you find yourself having to probe

score

Probing ExamplesHelpful probes can be found on all scoring sheets below the questions asked for each scenario.

You may think of more probing phrases not found here. Keepin mind that you should encourage the respondent to think

through his/her answer and further elaborate; you should notprobe in any way that "leads" the respondent

Tell me more about that

Can you explain a little more?


MED-SAIL Probing

Most assessments have directions that must be followed precisely, which means the administrator cannot

offer further help or clarification to the respondent. MED-SAIL is different. The MED

be encouraged to give the most complete answers possible so the administrator can understand and

record the respondent’s thought process. See specific instructions below.

Probing Instructions for the MED-SAIL Administrator:

If the respondent gives a vague answer without specific details:robing (see example phrases below) to encourage further elaboration

Ask another question

Rephrase the same question

Avoid asking questions that would lead the respondent to a particular answer or to a“yes” or “no” response

If the respondent still does not answer appropriately:

Continue further probing in the same mannerProbing and providing more details to your questions in encouragedContinue until it is clear that the respondent’s answer will not change significantly

If you find yourself having to probe for better responses, this should not lower the respondent’s

Helpful probes can be found on all scoring sheets below the questions asked for each scenario.



Tell me more about that Would that be a negative

or a positive thing?

Can you explain a little more?

Can you be more specific?

21

Most assessments have directions that must be followed precisely, which means the administrator cannot

SAIL is different. The MED-SAIL respondent must

ers possible so the administrator can understand and

robing (see example phrases below) to encourage further elaboration

Avoid asking questions that would lead the respondent to a particular answer or to a

Probing and providing more details to your questions in encouragedContinue until it is clear that the respondent’s answer will not change significantly

for better responses, this should not lower the respondent’s

Helpful probes can be found on all scoring sheets below the questions asked for each scenario.



Would that be a negative

or a positive thing?

Can you be more specific?


Domains Tested by MED-SAIL Questions

Understanding1. Please tell me in your own words

what I just saidThis question assesses whether a respondent can understand andrepeat a simple phrase back to you1, 2

Appreciation

2. Would this scenario be aproblem for you? Why or whynot?

This question is modeled on: 1) being open to the idea thattreatment may have benefits1 and 2) the ability to infer possiblebenefits of treatment.2

For MED-SAIL, this conceptual framework translates asunderstanding these scenarios are usually negative situations inwhich to find oneself.

Expressing a Choice

3. What would you do in thisscenario?

This question is viewed as “expressing a choice”. The literature onconsent to medical treatment1, 2 indicates that once a respondentthinks through possible options and how he or she feels about each,the doctor should ask the respondent to articulate a choice thatdescribes an action (i.e., “I will take medication A because it has theleast amount of side effects”).

With this question, you can screen for respondents who eithercannot articulate their choices/plans or express choices that mayindicate they have some impairment in decision making

Problem Solving / Consequential Reasoning

4. What would you do if(respondent’s answer to question#3) didn’t work?

This question is meant to push the respondent further and see ifhe/she can perform abstract problem solving in a new situation.The respondent may have given “rehearsed” answers to typicalquestions asked by the doctor.

This question is meant to get past those “rehearsed” answers byplacing the respondent in a new hypothetical situation

Comparative Reasoning5. So you’ve told me that

(respondent’s answer to question#3) and (respondent’s answer toquestion #4). Explain what isgood and bad about bothoptions.

This request is designed to test the respondent’s ability to comparetwo options by listing potential advantages and disadvantages ofeach answer.1

Reasoning – Generate Consequences

6. (a) What could you do to preventthis scenario from happening? or(b) What could you do toprepare for this scenario in caseit really happened?

Depending on the scenario, the administrator will find eitherquestion (a) or (b) listed. Some scenarios are situations that maynot be easy to prevent because they are accidents (i.e., a firestarting in your kitchen).

With these scenarios, it is more appropriate to ask how therespondent would prepare for the possibility of a particularaccident (i.e., he/she could buy a fire extinguisher and keep it in ahandy spot in the kitchen).

This question is meant to prompt the respondent to generate ideason how to prevent the scenario from happening or how to preparefor the scenario in case it does.


References

1. Appelbaum PS. Assessment of patients’ competence to consent to treatment. N Engl J Med.

2007;357(18):1834-18402. Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists (2008).

American Bar Association Commission on Law and Aging – American Psychology

Association.

Documents

MED-SAIL - NADRC · MED-SAIL was developed by a research team at Baylor College of Medicine (PI - Aanand D. Naik, MD) 2 MED-SAIL Scoring Summary Check completed scenarios below: 1