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Recognizing "Decision-Making Capacity"

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Recognizing "Decision-Making Capacity"

Post  Admin on Mon Nov 21, 2011 10:15 pm

Recognizing "Decision-Making Capacity"

Physicians often ask patients to make complex choices about diagnostic studies or treatments.
Medical decision-making capacity includes a patient's ability to understand relevant information and appreciate the consequences of a decision.
Physicians frequently lack formal training in assessing patients' capacity and regularly fail to identify patients who are incapable of making informed choices.

Researchers reviewed more than 40 high-quality prospective studies of inpatients, outpatients, and healthy controls in which medical decision-making capacity was evaluated with various instruments; patients with severe psychiatric illness were excluded.
Incapacity (as judged by a gold standard of forensic or expert psychiatric evaluation) was common in medical inpatients (26%);
physicians missed identifying patients with incapacity 58% of the time.

Although the Mini-Mental State Examination (MMSE) is not designed to assess decision-making capacity, scores <20 or >24 correlated with lower and higher likelihood of capacity, respectively, whereas scores of 20 to 24 did not correlate with capacity.

Of nine instruments that were compared with the gold standard, the Aid to Capacity Evaluation (ACE) performed best.
Furthermore, the ACE is free online and evaluates patients' actual decisions, unlike other instruments, which focus on unrelated clinical vignettes.

Click here for free online version of ACE:-
http://crashingpatient.com/wp-content/pdf/ACE.pdf

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