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

Owen, GS and Szmukler, G and Richardson, G and David, AS and Raymont, V and Freyenhagen, F and Martin, W and Hotopf, M (2013) 'Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study.' British Journal of Psychiatry, 203 (6). 461 - 467. ISSN 0007-1250

owen et al - bjp 2013 - dmc_psychiatric_v_medical.pdf

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Background: Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? Aims: To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. Method: 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. Results: Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<.001). Appreciation was a better 'test' of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02). Conclusions: 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.

Item Type: Article
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Humanities > Philosophy and Art History, School of
Depositing User: Jim Jamieson
Date Deposited: 14 Oct 2013 14:15
Last Modified: 22 Jan 2019 22:16

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