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Assessment of decisional capacity: Prevalence of medical illness and psychiatric comorbidities

Published online by Cambridge University Press:  30 October 2014

Susanne Boettger ,
Meredith Bergman ,
Josef Jenewein  and
Soenke Boettger
Susanne Boettger
Affiliation:
Department of Pediatrics, University Children's Hospital, University of Zurich, Zurich, Switzerland
Meredith Bergman
Affiliation:
Department of Psychiatry, Langone Medical Center, Bellevue Hospital Center, New York University, New York, New York
Josef Jenewein
Affiliation:
Department of Consultation–Liaison Psychiatry, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger*
Affiliation:
Department of Consultation–Liaison Psychiatry, University Hospital Zurich, Zurich, Switzerland
*
Address correspondence and reprint requests to: Soenke Boettger, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. E-mail: [email protected]
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Abstract

Objective:

Studies on decisional capacity have primarily focused on cognitive disorders, whereas noncognitive disorders remain understudied. The purpose of our study was to assess decisional capacity across a wide spectrum of medical and psychiatric disorders.

Method:

More than 2,500 consecutive consults were screened for decisional capacity, and 336 consults were reviewed at Bellevue Hospital Center in New York. Sociodemographic and medical variables, medical and psychiatric diagnoses, as well as decisional capacity assessments were recorded and analyzed.

Results:

Consults for decisional capacity were most commonly called for in male patients with cognitive and substance abuse disorders. Less commonly, consults were called for patients with mood or psychotic disorders. Overall, about two thirds of patients (64.7%) were deemed not to have decisional capacity. Among medical diagnoses, neurological disorders contributed to decisional incapacity, and among the psychiatric diagnoses, cognitive disorders were most frequently documented in cases lacking decisional capacity (54.1%) and interfered more commonly with decisional capacity than substance abuse or psychotic disorders (37.2 and 25%). In contrast, patients with mood disorders usually retained their decisional capacity (32%). Generally, the primary treatment team's assessment was accurate and was confirmed by the psychiatric service.

Significance of results:

Although decisional capacity assessments were most commonly requested for patients with substance abuse and cognitive disorders, the latter generally affected the ability to make healthcare decisions the most. Further, cognitive disorders were much more likely to impair the ability to make appropriate healthcare decisions than substance abuse or psychotic disorders.

Keywords

AssessmentDecisional capacityCompetencePsychiatric comorbiditiesMedical illness
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1275 - 1281
Copyright
Copyright © Cambridge University Press 2014 

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