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. DOI https://doi.org/10.1192/bjp.bp.112.123976
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. DOI https://doi.org/10.1192/bjp.bp.112.123976
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. DOI https://doi.org/10.1192/bjp.bp.112.123976
Abstract
<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><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><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 |
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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 Arts and Humanities Faculty of Arts and Humanities > Philosophical, Historical and Interdisciplinary Studies, School of |
SWORD Depositor: | Unnamed user with email elements@essex.ac.uk |
Depositing User: | Unnamed user with email elements@essex.ac.uk |
Date Deposited: | 14 Oct 2013 14:15 |
Last Modified: | 30 Oct 2024 16:39 |
URI: | http://repository.essex.ac.uk/id/eprint/8161 |
Available files
Filename: owen et al - bjp 2013 - dmc_psychiatric_v_medical.pdf