Validation of the French Version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in a French Sample of Individuals with Schizophrenia: Validation de la version française de l’instrument d’évaluation des compétences MacArthur-traitement (MacCAT-T) dans un échantillon français de personnes souffrant de schizophrénie

Abstract

Background: Assessing an individual’s capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients’ competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients’ decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia. Method: In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated. Results: The MacCAT-T’s internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of “understanding.” Component 2 included all subparts of “appreciation” and “reasoning” and was therefore labeled “reflexivity.” After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education. Conclusions: The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.

Capacity to consent to psychotherapy: Reliability of the newly adapted German version of the MacArthur Competence Assessment Tool for Treatment for psychotherapy

“…The major aim of the present study was to investigate the reliability of the German MacCAT-T adapted to the psychotherapeutical context The present findings are mainly in line with previous studies on the original MacCAT-T (Grisso et al, 1997) and versions in other languages (Aki et al, 2021;Hernando Robles et al, 2012;Lui et al, 2009;Raffard et al, 2021). Inter-rater reliability and consistency coefficients that were found for the MacCAT-PT total T A B L E 2 Descriptive statistics for the MacCAT-PT for the total sample and the subsamples.…”

“…Since symptom severity has already been found to have an effect on the CCT and decision-making of patients with schizophrenia (Raffard et al, 2021;Spencer et al, 2017), it can be assumed that it might also affect patients with other diagnoses as well. Therefore, future research on the CCT should consider symptom severity as a possible confounding factor to be controlled for.…”

“…A satisfactory inter-rater reliability and objectivity have already been shown for different translated versions of the MacCAT-T (Cairns et al, 2005;Hernando Robles et al, 2012;Lui et al, 2009;Raffard et al, 2021;Vollmann, 2008). However, a German version of the MacCAT-T adapted to psychotherapeutic treatments is still missing to this day.…”

Relationship Between Cognitive Functions and Decision-Making Capacity in Older Institutionalized Patients with Schizophrenia: A Preliminary Study

“…In the interview process, relevant treatment information was disclosed for a patient, and the patient’s mental capacity regarding treatment decisions was evaluated. 7 The MacCAT-T is validated in patients with schizophrenia, 15 and is widely used for evaluating decision-making capacity in this population. 16 Assessment of the MacCAT-T consists of four summary scores, which are named according to the dimensions of the treatment-related decision-making capacity as follows: (1) understanding (the ability to comprehend disclosed information regarding the condition and proposed treatment); (2) appreciation (the ability to appreciate the significance of the disclosed information for one’s own condition and situation); (3) reasoning (the ability to manipulate the relevant information rationally, eg, in comparing the risks and benefits of treatment options and the likely consequences of one’s choices); and (4) expression of a choice (the ability to arrive at and communicate a choice regarding a proposed treatment).…”

Holistic Solutions to Schizophrenia Management in Geriatric Populations

“…In order to ensure that their patients have sufficient cognitive capacity for consent, health professionals recommend utilizing the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) [47,48]. This 15 to 20 minute interview assesses the patient's ability to understand the nature of his or her treatment, as well as its risks, benefits, and alternative solutions [49].…”