Clinical Utility of the Hopkins Competency Assessment Test on an Inpatient Geropsychiatry Unit
Department of Psychiatry, University of Oklahoma College of Medicine-Tulsa, Tulsa, Oklahoma, USA.American Journal of Alzheimer s Disease and Other Dementias (Impact Factor: 1.63). 02/2009; 24(1):34-9. DOI: 10.1177/1533317508326374
This study examined the clinical use of routine administration of the Hopkins Competency Assessment Test on an inpatient geropsychiatry unit. The purpose was to determine whether the Hopkins Competency Assessment Test results influenced the psychiatrist's capacity assessment or confidence in that determination. The test was administered to all patients admitted voluntarily during an 18-week period. The attending psychiatrist determined treatment consent capacity and rated confidence in that determination, before and after review of the test results. Fifty seven patients were assessed. After review of the test results, the psychiatrist's capacity rating changed in only 2 (3.5%) cases. However, the test increased the psychiatrist's confidence ratings, particularly among the patients with cognitive impairment. The Hopkins Competency Assessment Test is not suited for routine administration among geropsychiatry inpatients. However, the test may serve a role as a supplementary tool for assessing treatment consent capacity among patients with evidence of cognitive impairment.
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- "As Appelbaum (2010) and Cairns et al. (2005) point out, clinical assessments may improve when standardized procedures such as the MacCAT-T are used in combination with clinical assessments. However, it has also been shown that physicians' assessments tend to be more lenient than psychometric assessments (Dunn et al., 2006; Raymont et al., 2004; Vellinga, Smitt, van Leeuwen, van Tilburg, & Jonker, 2004; Vollmann et al., 2003; Wilkins, Lund, Mc- Adams, & Yates, 2009). These findings were interpreted as showing that physicians were relatively insensitive to decisional impairment (Dunn et al., 2006) and tended to evaluate people as competent unless there was clear evidence to the contrary (Vellinga et al., 2004). "
ABSTRACT: We compared clinical assessments of capacity to consent to medical treatment with results obtained using the MacArthur Competence Tool for Treatment (MacCAT-T). Capacity to consent to treatment with antidementia drugs was assessed in 53 outpatients suffering from mild to moderate dementia. The prevalence of incapacity as evaluated by the physician was 52.8% and differed from the MacCAT-T psychometric assessment (81.1%). A final interdisciplinary assessment combined the two independent measures as well as all other available and relevant information, and concluded that 60.4% did not have the capacity to consent to medical treatment. Possible reasons for disagreement are the differing definitions and thresholds used to evaluate whether the necessary abilities are present, in particular for assessments of the ability " understanding. "
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ABSTRACT: When a patient's mental capacity to make decisions is open to question, the physician often calls in a psychiatrist to help make the determination. The psychiatrist's conclusions may be taken to a court to determine the patient's legal competency. In this article, the author presents several clinical criteria psychiatrists may use when determining patients' mental capacities. The author discusses two critical ethical questions psychiatrists should consider when they use this criteria: (1) whether they should use a fixed or sliding standard and (2) if they adopt a sliding standard, what clinical factors should be given the greatest weight. The author also discusses whether psychiatrists should take initiative to obtain a second opinion from another psychiatrist or mental health professional. Finally, the author discusses research regarding patients who are likely to have more impaired capacity for performing executive functions, patients requesting surgical procedures that are ethically without precedent, and patients possibly having inner awareness under conditions that previously were not considered possible.
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ABSTRACT: Capacity to consent to informed treatment decisions is an often overlooked, yet tremendously critical, aspect of modern medical practice. Despite its importance, research has shown that clinicians often fail to identify patients who lack capacity. Currently, other than a clinical psychiatric consultation and evaluation, there is no standardized method for determining whether a patient has capacity to make treatment decisions. Cognitive scales, such as the MMSE, may inform capacity evaluations but are neither sensitive nor specific. Accordingly, various clinical instruments have been developed to aid in the determination of capacity to consent to treatment. This is a review of several of these instruments. While there is no convincing evidence for the use of a particular scale, the CQ and ACE are easy to administer and can be efficiently utilized by clinicians to inform capacity assessment. While more time consuming to administer and score, the MacCAT-T also provides a comprehensive evaluation of key capacity domains.
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