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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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References

REFERENCES

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed., Text revision (DSM–IV–TR). Washington, DC: American Psychiatric Association. (see pp. 124–127).Google Scholar
Appelbaum, P.S. (2007). Clinical practice: Assessment of patients' competence to consent to treatment. The New England Journal of Medicine, 357, 1834–1840.Google Scholar
Appelbaum, P.S. & Grisso, T. (1988). Assessing patients' capacities to consent to treatment. The New England Journal of Medicine, 319, 1635–1638.Google Scholar
Barton, C.D. Jr., Mallik, H.S., Orr, W.B., et al. (1996). Clinicians' judgment of capacity of nursing home patients to give informed consent. Psychiatric Services, 47, 956–960.Google Scholar
Bial, A.K., Schilsky, R.L. & Sachs, G.A. (2006). Evaluation of cognition in cancer patients: Special focus on the elderly. Critical Reviews in Oncology/Hematology, 60, 242–255.Google Scholar
Candilis, P.J., Fletcher, K.E., Geppert, C.M., et al. (2008). A direct comparison of research decision-making capacity: Schizophrenia/schizoaffective, medically ill, and non-ill subjects. Schizophrenia Research, 99, 350–358.Google Scholar
Coleman, M.T. & Newton, K.S. (2005). Supporting self-management in patients with chronic illness. American Family Physician, 72, 1503–1510.Google Scholar
Cruzan v. Director, Missouri Department of Mental Health (1990). 497 U.S. 261, 278.Google Scholar
Etchells, E., Darzins, P., Silberfeld, M., et al. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 27–34.Google Scholar
Fitten, L.J., Lusky, R. & Hamann, C. (1990). Assessing treatment decision-making capacity in elderly nursing home residents. Journal of the American Geriatrics Society, 38, 1097–1104.Google Scholar
Freedman, M., Stuss, D.T. & Gordon, M. (1991). Assessment of competency: The role of neurobehavioral deficits. Annals of Internal Medicine, 115, 203–208.Google Scholar
Griffith, H.R., Dymek, M.P., Atchison, P., et al. (2005). Medical decision-making in neurodegenerative disease: Mild AD and PD with cognitive impairment. Neurology, 65, 483–485.Google Scholar
Gurrera, R.J., Moye, J., Karel, M.J., et al. (2006). Cognitive performance predicts treatment decisional abilities in mild to moderate dementia. Neurology, 66, 1367–1372.Google Scholar
Hamann, J., Bronner, K., Margull, J., et al. (2011). Patient participation in medical and social decisions in Alzheimer's disease. Journal of the American Geriatrics Society, 59, 2045–2052.Google Scholar
Kahn, D.R., Bourgeois, J.A., Klein, S.C., et al. (2009). A prospective observational study of decisional capacity determinations in an academic medical center. International Journal of Psychiatry in Medicine, 39, 405–415.Google Scholar
Karlawish, J. (2008). Measuring decision-making capacity in cognitively impaired individuals. Neurosignals, 16, 91–98.Google Scholar
Katz, M., Abbey, S., Rydall, A., et al. (1995). Psychiatric consultation for competency to refuse medical treatment. A retrospective study of patient characteristics and outcome. Psychosomatics, 36, 33–41.Google Scholar
Kim, S.Y. & Caine, E.D. (2002). Utility and limits of the Mini-Mental State Examination in evaluating consent capacity in Alzheimer's disease. Psychiatric Services, 53, 1322–1324.Google Scholar
Kloezen, S., Fitten, L.J. & Steinberg, A. (1988). Assessment of treatment decision-making capacity in a medically ill patient. Journal of the American Geriatrics Society, 36, 1055–1058.Google Scholar
Marson, D.C., Schmitt, F.A., Ingram, K.K., et al. (1994). Determining the competency of Alzheimer patients to consent to treatment and research. Alzheimer Disease and Associated Disorders, 8(Suppl. 4), 5–18.Google Scholar
Marson, D.C., Cody, H.A., Ingram, K.K., et al. (1995). Neuropsychological predictors of competency in Alzheimer's disease using a rational reasons legal standard. Archives of Neurology, 52, 955–959.Google Scholar
Moye, J., Karel, M.J., Gurrera, R.J., et al. (2006). Neuropsychological predictors of decision-making capacity over 9 months in mild-to-moderate dementia. Journal of General Internal Medicine, 21, 78–83.Google Scholar
Okai, D., Owen, G., McGuire, H., et al. (2007). Mental capacity in psychiatric patients: Systematic review. The British Journal of Psychiatry, 191, 291–297.Google Scholar
Raymont, V., Bingley, W., Buchanan, A., et al. (2004). Prevalence of mental incapacity in medical inpatients and associated risk factors: Cross-sectional study. Lancet, 364, 1421–1427.Google Scholar
Rodin, M.B. & Mohile, S.G. (2008). Assessing decisional capacity in the elderly. Seminars in Oncology, 35, 625–632.Google Scholar
Sessums, L.L., Zembrzuska, H. & Jackson, J.L. (2011). Does this patient have medical decision-making capacity? The Journal of the American Medical Association, 306, 420–427.Google Scholar
Sweatman, J. (2003). Good clinical practice: A nuisance, a help or a necessity for clinical pharmacology? British Journal of Clinical Pharmacology, 55, 1–5.Google Scholar
Umapathy, C., Ramchandani, D., Lamdan, R.M., et al. (1999). Competency evaluations on the consultation–liaison service: Some overt and covert aspects. Psychosomatics, 40, 28–33.Google Scholar
Weiss, B.D., Berman, E.A., Howe, C.L., et al. (2012). Medical decision making for older adults without family. Journal of the American Geriatrics Society, 60, 2144–2150.Google Scholar
Young, J. & Inouye, S.K. (2007). Delirium in older people. BMJ, 334, 842–846.Google Scholar