Assessment of Healthcare Decision-making Capacity

Palmer, Barton W.; Harmell, Alexandrea L.

doi:10.1093/arclin/acw051

Cited by 119 publications

(78 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While the absence of an association of neuropsychiatric symptoms with decisional capacity was contrary to our hypotheses, it parallels findings in schizophrenia where psychotic symptoms appear to be less predictive of capacity to consent to research or treatment than cognitive deficits (Palmer & Savla, 2007; Palmer et al, 2012). Note that mean levels of neuropsychiatric symptoms in our AD sample were low relative to the potential range of the CGA-NPI.…”

Section: Discussioncontrasting

confidence: 86%

“…Severity of cognitive deficits is a significant predictor of impaired decisional capacity (Palmer & Savla, 2007; Palmer, Savla, & Harmell, 2012). However, in addition to the cognitive deficits that typify AD, this disorder is frequently associated with neuropsychiatric symptoms such as mood disturbances, delusions, hallucinations, and agitation (Burke, Hall, & Tariot, 2013; Cantillon, De La Puente, & Palmer, 1998; Cummings & Zhong, 2015).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of Capacity to Consent to Research on Alzheimer’s Disease

Palmer

Harmell

Pinto

et al. 2016

Clinical Gerontologist

Self Cite

View full text Add to dashboard Cite

Objective Investigators conducting Alzheimer’s disease (AD) research need to consider participants’ capacity to consent. Cognitive functioning is a significant predictor of decisional capacity, but there is a dearth of information on the influence of neuropsychiatric symptoms in AD on decisional capacity. We examined the rates of decisional capacity associated with two types of research protocols, and the association of capacity with neuropsychiatric symptoms and other participant characteristics. Methods We comprehensively evaluated decisional capacity among 64 patients with mild-to-moderate AD and 70 healthy comparison (HC) subjects randomized to consider either a medium risk or higher risk hypothetical research protocol. Additional measures included sociodemographics, cognitive deficits, and neuropsychiatric symptoms. Results Twenty AD patients (31.3%) and 67 HCs (95.7%) were deemed capable; 44 AD patients (68.8%) and 3 HCs (4.3%) incapable of consent. Age, education, and severity of cognitive deficits were associated with incapable status; there were no significant associations with severity of neuropsychiatric symptoms or protocol risk level. Conclusions Findings highlight the importance of understanding of capacity and its assessment among people with AD, rather than treating AD diagnosis as synonymous with impaired capacity. As novel treatments move from bench to bedside, methods of assessing and addressing capacity impairment must similarly advance. Clinical Implications In assessing research consent capacity, use structured assessments with population specific cut scores interpreted in the context of the person’s background including education, culture, and language. Individuals should be encouraged to execute research proxy documents when able.

show abstract

Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Determinants of Capacity to Consent to Research on Alzheimer’s Disease

Palmer

Harmell

Pinto

et al. 2016

Clinical Gerontologist

Self Cite

View full text Add to dashboard Cite

show abstract

“…As noted above, empirical research has consistently shown that severity of cognitive deficits, rather than severity of primary psychopathologic symptoms, to be the strongest predictor of decisional capacity (reviewed in Palmer & Harmell, 2016). However, decision making capacity is an inherently context-dependent construct – affected by the inherent complexity of the information and decision, as well as the manner in which the information is communicated complexity (Dunn, Palmer, & Karlawish, 2007).…”

Section: Decision Making Capacity In People With Smimentioning

confidence: 96%

Supported Decision Making in Serious Mental Illness

Jeste¹,

Eglit

Palmer

et al. 2018

Psychiatry

Self Cite

View full text Add to dashboard Cite

Objective: Making decisions is central to the exercise of control over one’s well-being. Many individuals with serious mental illnesses (SMI) experience limitations in their decision making capacity. These individuals have often been placed under legal guardianship, and substitute decision makers have been appointed to make decisions on their behalf. More recently, Supported Decision Making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual’s capacity in the decision making process, enabling them to retain autonomy in life decisions. This overview examines issues associated with decision making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM. Method: Overview of medical and legal literature. Results: Many, but not all, individuals with SMI exhibit decrements in decision making capacity and skill, in part due to cognitive impairment. There is no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers. Conclusions: SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided.

show abstract

“…placebo treatments). Furthermore, Palmer and Harmell (2016) reported association between certain neurocognitive domains and healthcare decision-making, such as episodic memory, naming, working memory, executive functions and speed. The authors also summarised previously findings of what cognitive abilities appear to be correlated to different components of decision-making capacity:…”

Section: Associated Cognitive and Linguistic Functionsmentioning

confidence: 99%

“…Estimation of cognitive severity by for example Mini Mental State Examination (MMSE; Folstein, Folstein & McHugh, 1975) Karlawish, 2017;Palmer and Harmell, 2016;Lamont, Jeon & Chiarella, 2013;Pennington et al, 2018). Some well-established instruments to assess different aspects of the capacity are:…”

Section: Testsmentioning

confidence: 99%

Decisions and attitudes regarding participation and proxy in clinical trials among patients with impaired cognitive function

Stormoen¹,

Tallberg

Almkvist

et al. 2017

Dementia

View full text Add to dashboard Cite

Background Medical decision-making capacity is impaired in Alzheimer's disease and mild cognitive impairment. Medical decision-making capacity depends on many different cognitive functions and varies due to situation and cognitive, social, and emotional status of the patient. Our aim was to analyze dementia patients' capacity to estimate risks and benefits in different clinical trials and determine how cognitive decline affects their attitude toward possible participation and proxy consent. Methods Groups: Alzheimer's disease (n = 20), mild cognitive impairment (n = 21) and healthy controls (n = 33). Two hypothetical clinical trials, a standardized interview and three visual analogue scales were used to investigate decisions, estimations, reasoning, and attitudes. Results A general positive attitude toward participation in clinical trials was shown among all groups. Both patients and controls motivated possible participation as "own-benefit" in the low-risk trial and to "help-others" in the high-risk trial. Individuals who accepted to participate in the high-risk trial scored lower in medical decision-making capacity in comparison to participants who would not have participated (p < .01). Patients in the Alzheimer's disease but not mild cognitive impairment and healthy control groups underestimated risks and overestimated benefits in the high-risk/low-benefit trial (p < .05). A family member was most frequently chosen as possible proxy (91%). Conclusions Medical decisions and research consent should be interpreted with caution in patients who are already in early stages of dementia, as the patients' acceptance to participate in high-risk trials may be due an insufficient decisional capacity and risk analysis, accelerated by a general desire to make good to society. We emphasize the use of a standardized tool to evaluate medical decisional capacity in clinical research.

show abstract

Assessment of Healthcare Decision-making Capacity

Cited by 119 publications

References 82 publications

Determinants of Capacity to Consent to Research on Alzheimer’s Disease

Determinants of Capacity to Consent to Research on Alzheimer’s Disease

Supported Decision Making in Serious Mental Illness

Decisions and attitudes regarding participation and proxy in clinical trials among patients with impaired cognitive function

Contact Info

Product

Resources

About