Medical Patients’ Treatment Decision Making Capacity: A Report from a General Hospital in Greece

Abstract

This study aimed to assess the decision-making capacity for treatment of patients hospitalized in an internal medicine ward of a General Hospital in Greece, and to examine the views of treating physicians regarding patients’ capacity. All consecutive admissions to an internal medicine ward within a month were evaluated. A total of 134 patients were approached and 78 patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini Mental State Examination (MMSE) questionnaire. Sixty-eight out of 134 patients (50.7%) were incompetent to decide upon their treatment. The majority of them (n=56, 41.8%) were obviously incapable because they were unconscious, or had such marked impairment that they could not give their own names, and the rest (n=12, 8.9%) were rated as incompetent according to their performance in the MacCAT-T. Neurological disorders, old age and altered cognitive function according to MMSE were negatively correlated with decision making capacity. Physicians sometimes failed to recognize patients’ incapacity. Rates of decision-making incapacity for treatment in medical inpatients are high, and incapacity may go unrecognized by treating physicians. Combined patient evaluation with the use of the MacCAT-T and MMSE, could be useful for the determination of incapable patients.

Treatment decision-making capacity in hospitalized patients with schizophrenia

“…The recruitment of a sufficient sample size of younger internal medicine patients would have take a much longer interval, because, by definition, physical morbidity is less common in younger peo-ple. Importantly, higher age was associated with incapacity in internal medicine patients, 13 and if these patients had been matched to patients with schizophrenia the observed differences would probably have been even greater. Within the group of patients with schizophrenia comparisons regarding DMC were not made between the voluntarily (n=8) and involuntarily (n=13) admitted patients, because the number would be too small to find a reliable correlation.…”

Qualitative analysis of the capacity to consent to treatment in patients with a chronic neurodegenerative disease: Alzheimer’s disease / Analisi qualitativa sulla capacità a prestare consenso al trattamento in pazienti con malattie cronico degenerative neuropsicoorganiche: Demenza di Alzheimer

“…In recent years, several studies have addressed this issue in an attempt to evaluate the patient’s mental capacity to give consent in various clinical settings (Aydin, Sehiralti, & Aker, 2013; Bilanakis, Vratsista, Athanasiou, Niakas, & Peritogiannis, 2014; Carabellese et al, 2017; Kerrigan, Erridge, Liaquat, Graham, & Grant, 2014; Mandarelli et al, 2017; Okai et al, 2007; Owen et al, 2013; Raymont et al, 2004; Catanesi, Carabellese, Candelli, La Tegola, & Taratufolo, 2010).…”