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Ng IK. Informed consent in clinical practice: Old problems, new challenges. J R Coll Physicians Edinb 2024; 54:153-158. [PMID: 38616290 DOI: 10.1177/14782715241247087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Informed consent is a fundamental tenet of patient-centred clinical practice as it upholds the ethical principle of patient autonomy and promotes shared decision-making. In the medicolegal realm, failure to meet the accepted standards of consent can be considered as medical negligence which has both legal and professional implications. In general, valid consent requires three core components: (1) the presence of mental capacity - characterised by the patient's ability to comprehend, retain information, weigh options and communicate the decision, (2) adequate information disclosure - based on the 'reasonable physician' or 'reasonable patient' standards and (3) voluntariness in decision-making. Nonetheless, in real-world clinical settings, informed consent is not always optimally achieved, due to various patient, contextual and systemic factors. In this article, I herein discuss three major challenges to informed consent in clinical practice: (1) patient literacy and sociocultural factors, (2) psychiatric illnesses and elderly patients with cognitive impairment and (3) artificial intelligence in clinical care, and sought to offer practical mitigating strategies to address these barriers.
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Affiliation(s)
- Isaac Ks Ng
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Marcó-García S, Ariyo K, Owen GS, David AS. Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis. Psychol Med 2024; 54:1074-1083. [PMID: 38433596 DOI: 10.1017/s0033291724000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.
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Affiliation(s)
- Silvia Marcó-García
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopathogenesis and treatment of severe mental disorders (MERITT), Sant Joan de Déu Research Institute, Sant Joan de Déu Foundation, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | - Kevin Ariyo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gareth S Owen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Division of Psychiatry, UCL Institute of Mental Health, University College London, London, UK
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Peritogiannis V, Tsoli F, Gioti P, Bakola M, Jelastopulu E. Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece. J Clin Med 2023; 12:jcm12072508. [PMID: 37048591 PMCID: PMC10095177 DOI: 10.3390/jcm12072508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Data on the use of long-acting injectable antipsychotics (LAIs) in rural community mental healthcare settings are scarce. This study aimed to investigate the prescription patterns of LAIs in a clinical sample of patients with schizophrenia-spectrum disorders in rural Greece. All patients with schizophrenia-spectrum disorders who regularly attend the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T) in northwestern Greece were included in the study. The sample consists of 87 patients (59 males and 28 females) with a mean age of 54.4 years and a mean illness duration of 28 years. Most patients (72.4%) received antipsychotic monotherapy, and nearly 30% received an LAI formulation, mostly a second-generation LAI (20 of 26 patients, 76.9%). The treatment regimen comprised benzodiazepines in one-third of the patients and antidepressants in one-quarter. There was no statistically significant association between treatment regimen and the clinical and demographic variables studied, except for biological sex (female). The percentage of patients treated with LAIs in this study was almost three times higher than the rate previously reported in Greece and is higher than the rates reported in other countries. Patients with schizophrenia-spectrum disorders in rural Greece may have adequate access to innovative treatment with second-generation LAIs. Further research is needed to demonstrate the cost-effectiveness of LAI treatment in rural communities and to elucidate the factors associated with such treatment.
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Peritogiannis V, Drakatos I, Gioti P, Garbi A. Vaccination rates against COVID-19 in patients with severe mental illness attending community mental health services in rural Greece. Int J Soc Psychiatry 2023; 69:208-215. [PMID: 35253527 PMCID: PMC9936167 DOI: 10.1177/00207640221081801] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with severe mental illness (SMI) may be at increased risk for COVID-19-related severe morbidity and mortality. There is limited research on the vaccination rates against COVID-19 in patients with SMI. AIMS The objective of the present study is to explore vaccination rates and co-relations in patients with SMI, attending community mental health services, namely the Mobile Mental Health Units (MMHUs) in rural Greece. METHOD All treatment engaged patients with SMI (schizophrenia-spectrum or bipolar disorder) with two MMHUs (MMHU of Kefalonia, Zakynthos and Ithaca, [MMHU KZI] and MMHU of the prefectures of Ioannina and Thesprotia [MMHU I-T]) in rural Greece were enrolled prospectively over a six-month period. The MMHU I-T had adopted a more proactive approach to patients' vaccination, by informing patients and caregivers for its benefits. RESULTS Data were analyzed for 197 patients with SMI. The overall vaccination rate was 68.5% and did not differ from the respective rates in the general population. There were no differences in vaccination rates among patients attending the two MMHUs, nor among patients with different diagnoses (schizophrenia spectrum disorders or bipolar disorder). Vaccination was not associated with gender, educational level, history of alcohol and substance abuse, illness duration, or number of previous hospitalizations, whereas the effect size of age was moderate. In more than half non-vaccinated patients the refusal to get vaccinated was associated with fears and concerns as well as false beliefs that are encountered in the general population. CONCLUSION In the present sample of treatment-engaged rural patients vaccination rates against COVID-19 appear to be satisfactory. There were no differences in vaccination rates with regard to the interventions that were applied to enhance vaccination. It seems that other forms of intervention should be applied to reluctant patients to modify their attitudes toward vaccination.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Ioannis Drakatos
- Mobile Mental Health Unit of Kefalonia, Zakynthos and Ithaca, METAVASI, Argostoli, Kefalonia, Greece
| | - Panagiota Gioti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Aikaterini Garbi
- Mobile Mental Health Unit of Kefalonia, Zakynthos and Ithaca, METAVASI, Argostoli, Kefalonia, Greece
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Curley A, Watson C, Kelly BD. Capacity to consent to treatment in psychiatry inpatients - a systematic review. Int J Psychiatry Clin Pract 2022; 26:303-315. [PMID: 34941467 DOI: 10.1080/13651501.2021.2017461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mental capacity for treatment decisions in psychiatry inpatients is an important ethical and legal concern, especially in light of changes in mental capacity legislation in many jurisdictions. AIMS To conduct a systematic review of literature examining the prevalence of mental capacity for treatment decisions among voluntary and involuntary psychiatry inpatients, and to assess any correlations between research tools used to measure mental capacity and binary judgements using criteria such as those in capacity legislation. METHOD We searched PsycINFO, Ovid MEDLINE and EMBASE for studies assessing mental capacity for treatment decisions in people admitted voluntarily and involuntarily to psychiatric hospitals. RESULTS Forty-five papers emanating from 33 studies were identified. There was huge variability in study methods and often selective populations, but the prevalence of decision-making capacity varied between 5% and 83.7%. These figures resulted from studies using cut-off scores or categorical criteria only. The prevalence of decision-making capacity among involuntary patients ranged from 7.7% to 42%, and among voluntary patients ranged from 29% to 97.9%. Two papers showed positive correlations between clinicians' judgement of decision-making capacity and scores on the MacArthur Competence Assessment Tool for Treatment; two papers showed no such correlation. CONCLUSIONS Not all voluntary psychiatry inpatients possess mental capacity and many involuntary patients do. This paradox needs to be clarified and resolved in mental health legislation; supported decision-making can help with this task.Key PointsLegislative changes for mental capacity are taking place in many jurisdictions.This is an important human rights issue for many people, including psychiatry inpatients.In our review, we found the prevalence of decision-making capacity varies between 5% and 83.7% in psychiatry inpatients.Not all voluntary inpatients have decision-making capacity.Many involuntary inpatients have mental capacity to make decisions.Supported decision-making can help those with impairments in their mental capacity.
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Affiliation(s)
- Aoife Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland.,Cavan Monaghan Mental Health Service, Monaghan, Ireland
| | - Carol Watson
- Cavan Monaghan Mental Health Service, Monaghan, Ireland
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland
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Raffard S, Lebrun C, Laraki Y, Capdevielle D. 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. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:395-405. [PMID: 33064578 PMCID: PMC8172341 DOI: 10.1177/0706743720966443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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.
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Affiliation(s)
- Stéphane Raffard
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Cindy Lebrun
- 27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Yasmine Laraki
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,Inserm, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, France
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Nystazaki M, Pikouli K, Tsapakis EM, Karanikola M, Ploumpidis D, Alevizopoulos G. Decision-making Capacity for Treatment of Psychotic Patients on Long Acting Injectable Antipsychotic Treatment. Arch Psychiatr Nurs 2018; 32:300-304. [PMID: 29579528 DOI: 10.1016/j.apnu.2017.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Providing informed, consent requires patients' Decision-Making Capacity for treatment. We evaluated the Decision Making Capacity of outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotic medication. METHOD This is a retrospective, cross-sectional, correlational study conducted at two Depot Clinics in Athens, Greece. Participants included 65 outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotics. RESULTS Over half of the participants showed poor understanding of the information given regarding their disease and treatment (Understanding subscale), however >70% seemed to comprehend the relevance of this information to their medical condition (Appreciation subscale). Moreover, half of the participants reported adequate reasoning ability (Reasoning subscale), whilst patients who gained >7% of their body weight scored statistically significantly higher in the subscales of Understanding and Appreciation. CONCLUSION Our results suggest that there is a proportion of patients with significantly diminished Decision Making Capacity, hence a full assessment is recommended in order to track them down. Further research is needed to better interpret the association between antipsychotic induced weight gain and Decision Making Capacity in patients suffering from schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Maria Nystazaki
- Department of Psychiatry, University of Athens "Agioi Anargyroi" Hospital, Athens, Greece.
| | - Katerina Pikouli
- Byron-Kaisariani Community Mental Health Centre, "Eginition" University Psychiatric Hospital, Athens, Greece
| | | | - Maria Karanikola
- Department of Nursing, Technological University of Cyprus, Limassol, Cyprus
| | - Dimitrios Ploumpidis
- Athens University Medical School, Community Mental Health Centre Byron-Kaisariani, "Eginition" University Psychiatric Hospital, Athens, Greece
| | - Giorgos Alevizopoulos
- National and Kapodistrian University of Athens, "Agioi Anargyroi" Hospital, Department of Psychiatry, Zografou Community Mental Health Centre, Athens, Greece
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Carabellese F, Felthous AR, La Tegola D, Piazzolla G, Distaso S, Logroscino G, Leo A, Ventriglio A, Catanesi R. 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. Int J Soc Psychiatry 2018; 64:26-36. [PMID: 29183264 DOI: 10.1177/0020764017739642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Informed consent is an essential element in doctor-patient relationship. In particular, obtaining valid informed consent from patients with neurocognitive diseases is a critical issue at present. For this reason, we decided to conduct research on elderly patients with Alzheimer's disease ( Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to assess their capacity to make treatment decisions. METHODS The experimental group comprised 70 Alzheimer patients who were admitted to the Neurodegenerative Disease Unit of the University of Bari. The control group consisted of 83 elderly patients without neurocognitive disorders who were hospitalized in the Geriatric Unit at the same university. After providing written consent to participate in the research, each subject underwent the following assessments: (a) assessment of comprehension sheet, (b) Neuropsychiatric Inventory (NPI) and Global Functioning Evaluation (GFE), (c) neurological evaluation, (d) neuropsychological assessment with a full battery of tests, (d) The MacArthur Treatment Competence Study (MacArthur Competence Assessment Tool for Treatment (MacCAT-T); understanding, appreciating, reasoning and expressing a choice) and (e) a semi-structured interview administered by the patient's caregiver. RESULTS/CONCLUSION The present survey was designed to analyze possible qualitative and quantitative correlations between cognitive functioning and capacity to consent in relation to different degrees of severity of the neurodegenerative disorder. A large portion of the patients in our experimental sample did not appear to have the capacity to provide a valid consent. The authors present initial results of this study and discuss their possible implications.
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Affiliation(s)
- Felice Carabellese
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | - Alan R Felthous
- 2 Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Donatella La Tegola
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | | | - Salvatore Distaso
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | - Giancarlo Logroscino
- 4 Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Leo
- 4 Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Ventriglio
- 5 Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Roberto Catanesi
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
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Saber A, Tabatabaei SM, Akasheh G, Sehat M, Zanjani Z, Larijani B. Face and Content Validity of the MacArthur Competence Assessment Tool for the Treatment of Iranian Patients. Int J Prev Med 2017; 8:75. [PMID: 29026507 PMCID: PMC5634061 DOI: 10.4103/ijpvm.ijpvm_367_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 07/08/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is not a valid Persian tool for measuring the decision-making competency of patients. The aim of this study is to evaluate the face and content validity of the MacArthur Competence Assessment Tool for the treatment of Iranian Persian-speaking patients. METHODS To assess the validity of the Persian version of the tool, a self-administrated questionnaire was designed. The Lawshe method was also used for assessing each item. Content validity ratio (CVR) and content validity index (CVI) were used to assess the content validity quantitatively. According to the experts' judgment, questions with a CVR ≥0.62 and CVR <0.62 were maintainable and unmaintainable, respectively. RESULTS The questions were designed in a manner to achieve the desirable result (CVR ≥0.62). The CVI scale (S-CVI) and CVI (S-CVI/Ave) were 0.94 (higher than 0.79). Thus, the content validity was confirmed. CONCLUSIONS Since capacity assessments are usually based on physician's subjective judgment, they are likely to bias and therefore, with this suitably validated tool, we can improve judgment of physicians and health-care providers in out- and in-patient cases.
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Affiliation(s)
- Ali Saber
- PhD in Medical Ethics, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mahmoud Tabatabaei
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Godarz Akasheh
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Department of Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Zanjani
- Department of Psychology, Medical Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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Saber A, Tabatabaei SM, Akasheh G, Sehat M, Zanjani Z, Larijani B. Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e33464. [PMID: 27148503 PMCID: PMC4853637 DOI: 10.5812/atr.33464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 10/25/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
Background According to general ethical and legal principles, valid consent must be obtained before starting any procedure. Objectives Due to the lack of a standard tool for assessing patients’ capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool. Patients and Methods By reviewing different methods of cultural translation and adaptation for assessment tools, and due to the lack of consensus on its processes, we selected Wild’s model as one of the most comprehensive methods in this regard. Wild’s (2005) 10-stage model includes preparation, forward translation, reconciliation of the forward translation, back translation of reconciliation, back translation review, cognitive debriefing and cognitive review, and finalization, proofreading and final reporting. Using this model, we translated the MacArthur assessment tool and made it adaptable to Iranian patients. Results The MacArthur assessment tool is not dependent on any specific culture and language. As a result, if translation and its scientific adaptation are done based on an integrated and detailed model, the tool can be used for every culture and language. In other words, this tool is not culture-specific; so, it is applicable in cases where a translation is needed, and it can be culturally adapted to suit different societies. Conclusions In the present study, we are able to focus on and prove the efficacy and benefits of this measurement tool.
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Affiliation(s)
- Ali Saber
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mahmoud Tabatabaei
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Goodarz Akasheh
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zahra Zanjani
- Department of Psychology, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Bagher Larijani, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166419661, Fax: +98-2166953832, E-mail:
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Bilanakis N, Vratsista A, Athanasiou E, Niakas D, Peritogiannis V. Medical patients' treatment decision making capacity: a report from a general hospital in Greece. Clin Pract Epidemiol Ment Health 2014; 10:133-9. [PMID: 25505489 PMCID: PMC4260233 DOI: 10.2174/1745017901410010133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/26/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022]
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.
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Affiliation(s)
| | | | - Eleni Athanasiou
- Department of Internal Medicine, General
Hospital of Arta, Arta, Greece
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