No abstract

20 vastly increases the likelihood of incapacity. 2 A variety of validated tools exist to aid the assessment of decision-making capacity such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Clinicians often overestimate their patient's decision-making capacity. 2,3 Raymont et al 4 investigated the prevalence of mental incapacity in a cross-sectional study in London and found that incapacity was rarely detected by clinicians or relatives. While the authors noted there was little conflict between patients and treating physicians with regard to treatment decisions, it still leaves the possibility of patients making decisions they do not have the capacity to make. There is a potential for clinical harm, as well as the violation of autonomous choices, if protective measures are not in place because a patient is wrongly assumed to have decision-making capacity. No review so far has compared prevalence of incapacity in two or more different settings. The aim of our review is to estimate the prevalence of incapacity to consent to treatment or admission in different settings. We have included medical and psychiatric patients covering inpatient, outpatient and other settings as well as subspecialities within psychiatry. The results provide guidance to the level of incapacity that clinicians should expect in a variety of different settings. We also compared medical and psychiatric settings to see whether there is a significant difference. Methods We followed PRISMA principles for systematic reviews. We searched all articles published until November 2013 in Embase, Medline or Psychinfo. We used the following search terms: mental competency/or capacity assessments or decision making/informed consent/or consent to treatment in medical wards or hospital units/inpatients or inpatients hospitals, psychiatric/or schizophrenia/or depressive disorder/or mental disorders/or psychiatric patients substance-related disorders/or mood disorders. Inclusion criteria: > participants: any medical or psychiatric patients > assessment: conducted with a validated tool > data about the prevalence of incapacity were either stated directly or were possible to calculate from the available data > data were presented in a binary way (either patients had capacity or not) > any setting including mixed settings > reporting: published in peer review journals and available as electronic or paper full text in any language. Recent court cases in England and Wales have refocused attention on patients' decision-making capacity to consent. Little is known about the prevalence of incapacity across specialities but decision-making capacity is likely to be overestimated by clinicians. The aim of this systematic review is to estimate the prevalence of incapacity to consent to treatment or admission in different medical and psychiatric settings, and compare the two. We conducted an electronic search following PRISMA principles and included 35 studies in psychiatric and 23 studies in medical settings. The 58 included studies revealed 70 data set...

Although quality of many studies was not optimal, the results of this meta analysis support the results of earlier meta analyses. Group cognitive behavioural therapy is effective in older adults with depression.