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Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study

Owen, Gareth S and Szmukler, George and Richardson, Genevra and David, Anthony S and Raymont, Vanessa and Freyenhagen, Fabian and Martin, Wayne and Hotopf, Matthew (2013) 'Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study.' British Journal of Psychiatry, 203 (6). pp. 461-467. ISSN 0007-1250

owen et al - bjp 2013 - dmc_psychiatric_v_medical.pdf

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<jats:sec><jats:title>Background</jats:title><jats:p>Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool – Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (<jats:italic>P</jats:italic>=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric <jats:italic>v.</jats:italic> 13% medical in-patients, <jats:italic>P</jats:italic>&lt;0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (<jats:italic>P</jats:italic>&lt;0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (<jats:italic>P</jats:italic>=0.02).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.</jats:p></jats:sec>

Item Type: Article
Uncontrolled Keywords: Humans; Acute Disease; Cross-Sectional Studies; ROC Curve; Mental Competency; Comprehension; Decision Making; Personal Autonomy; Cognition Disorders; Interview, Psychological; Informed Consent; Adult; Middle Aged; Mentally Ill Persons; Inpatients; Hospitals, General; Hospitals, Psychiatric; Female; Male
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Humanities
Faculty of Humanities > Philosophy and Art History, School of
SWORD Depositor: Elements
Depositing User: Elements
Date Deposited: 14 Oct 2013 14:15
Last Modified: 15 Jan 2022 00:40

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