Assessment of patient capacity to consent to treatment

Abstract

OBJECTIVE:To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment. DESIGN:Cross-sectional study with independent comparison to expert capacity assessments. SETTING:Inpatient medical wards at an academic secondary and tertiary referral hospital. PARTICIPANTS:One hundred consecutive inpatients facing a decision about a major medical treatment or an invasive medical procedure. Participants either were refusing treatment, or were accepting treatment but were not clearly capable according to the treating clinician. MEASUREMENTS AND MAIN RESULTS:The treating clinician (medical resident or student) conducted a specific capacity assessment on each participant, using a decisional aid called the Aid to Capacity Evaluation. A specific capacity assessment is a semistructured evaluation of the participant's ability to understand relevant information and appreciate reasonably foreseeable consequences with regard to the specific treatment decision. Participants also received a SMMSE administered by a research nurse. Participants then had two independent expert assessments of capacity. If the two expert assessments disagreed, then an independent adjudication panel resolved the disagreement after reviewing videotapes of both expert assessments. Using the two expert assessments and the adjudication panel as the reference standard, we calculated areas under the receiver-operating characteristic curves and likelihood ratios. The areas under the receiveroperating characteristic curves were 0.90 for specific capacity assessment by treating clinician and 0.93 for SMMSE score (2 p ‫؍‬ .48). For the treating clinician's specific capacity assessment, likelihood ratios for detecting incapacity were as follows: definitely incapable, 20 (95% confidence interval [CI] 3.6, 120); probably incapable, 6.1 (95% CI 2.

Informed consent for research in ICU obtained before ICU admission

“…First, the patient has to receive adequate information about the study, with a complete disclosure of the risks and benefits from the investigator (disclosure) [3]. Second, the patient should be able to understand the implications of this research and the potential consequences of his decision to participate (decision-making capacity) [4]. Third, the patient should be able to decide freely to participate without any external pressure and to resign from the study at any time without any consequences on his care (voluntariness) [5].…”

Lost in the Present: Anterograde Amnesia and Medical Decision Making Capacity

“…After an interval of 10 minutes, LN was unable to recall any of the target words, even with category and forced choice assistance. Structured and semi-structured interview instruments, such as the Assessment of the Capacity to Consent to Treatment (ACCT) interview [26] and Aid to Capacity Evaluation (ACE) [27] can assist clinicians in evaluating DMC.…”

Importance of mental capacity: time for greater attention and action

“…(8) Other well-known validated tools such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), (9) despite its excellent inter-rater reliability and ease of use, was not included in Sessums et al's review, as it does not have a gold standard comparator. In the same systematic review, the authors found that the Mini-Mental State Examination (MMSE), which is not designed to assess incapacity, is most commonly used in clinical practice to evaluate a patient's mental capacity.…”