Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers

Abstract Metastatic cancer patients undergo numerous treatment strategies with known cognitive side effects. It is unclear how medical decision-making capacity (MDC) is impacted by cognitive deficits in metastatic cancer. This study examines reliability of an objective measure of MDC compared with self-report. Participants with newly diagnosed metastasis to the brain and other sites were enrolled at the University of Alabama at Birmingham over seven years. At the study visit, participants completed a comprehensive neuropsychological battery including memory and executive functioning, and the Capacity to Consent to Treatment Instrument (CCTI) assessing medico-legal domains of MDC. The CCTI is a reliable and valid instrument containing two vignettes of hypothetical medical situations assessing four standards of consent. We examined reliability between the CCTI and self-reported MDC using Gwet’s AC1 statistic. Participants with brain metastasis with impairment on the CCTI demonstrated significantly lower executive functioning and memory skills than those without impairment (Trails B Raw: 158.20±86.82 vs. 118.90±77.98 p: 0.0248; Digit-Span Raw Forward: 9.13±2.30 vs. 10.12±2.03 p: 0.0254). There were no significant differences between intact and impaired participants with other metastases. Low reliability was observed between self-report and all medico-legal standards on the CCTI across both metastatic groups [Gwet’s AC1 Appreciation: 0.70 (0.58, 0.81); Reasoning: 0.34 (0.16, 0.52); Understanding: 0.44, (0.27, 0.60)]. Self-rating of MDC is unreliable in metastatic cancer patients. Patients with metastases (particularly brain metastases) may lack awareness of deficits in their MDC, so providers must affirm proper autonomy in their decisions.

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Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery

Medicine Science and the Law ◽

10.1177/0025802419865854 ◽

2019 ◽

Vol 59 (4) ◽

pp. 247-254 ◽

Cited By ~ 1

Author(s):

Gabriele Mandarelli ◽

Giovanna Parmigiani ◽

Felice Carabellese ◽

Silvia Codella ◽

Paolo Roma ◽

...

Keyword(s):

Informed Consent ◽

Orthopaedic Surgery ◽

Decisional Capacity ◽

Capacity To Consent ◽

Capacity Evaluation ◽

Decision Making Capacity ◽

Consent To Treatment ◽

Major Orthopaedic Surgery ◽

Pain Symptoms ◽

State Examination

Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.

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4. Consent to Treatment

Medical Law and Ethics ◽

10.1093/he/9780198810605.003.0004 ◽

2018 ◽

Author(s):

Jonathan Herring

Keyword(s):

Mental Capacity ◽

Best Interests ◽

Living Wills ◽

Ethical Aspects ◽

Capacity To Consent ◽

Delicate Balance ◽

Mental Capacity Act 2005 ◽

Consent To Treatment ◽

Advance Decisions ◽

Mental Capacity Act

This chapter examines the legal and ethical aspects of treating a patient without consent. It considers the meaning of ‘consent’ and the position of patients who lack the capacity to consent. For children who lack capacity, consent involves a delicate balance between the rights of the children and those of their parents. For adults lacking capacity, the Mental Capacity Act 2005 has emphasized the ‘best interests’ test, but has largely left open the question of how a person’s best interests are to be ascertained. The chapter also considers what weight should be attached to advance decisions (sometimes called living wills).

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The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization

Journal of Empirical Research on Human Research Ethics ◽

10.1525/jer.2012.7.5.63 ◽

2012 ◽

Vol 7 (5) ◽

pp. 63-70 ◽

Cited By ~ 17

Author(s):

Gabriele Mandarelli ◽

Giovanna Parmigiani ◽

Lorenzo Tarsitani ◽

Paola Frati ◽

Massimo Biondi ◽

...

Keyword(s):

Executive Functions ◽

Psychiatric Hospitalization ◽

Capacity To Consent ◽

Consent To Treatment ◽

The Relationship

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46MEASURING HEALTH RELATED QUALITY OF LIFE OF CARE HOME RESIDENTS, COMPARISON OF SELF-REPORT BY OLDER PEOPLE WITH CAPACITY TO CONSENT AND STAFF PROXIES USING EQ-5D-5L AND HOWRU

Age and Ageing ◽

10.1093/ageing/afy121.11 ◽

2018 ◽

Vol 47 (suppl_3) ◽

pp. iii14-iii17

Author(s):

A Usman ◽

S Lewis ◽

K Hinsliff-Smith ◽

A Long ◽

G Housley ◽

...

Keyword(s):

Quality Of Life ◽

Older People ◽

Care Home ◽

Self Report ◽

Health Related Quality ◽

Capacity To Consent ◽

Related Quality ◽

Health Related

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Validation of the French Version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in a French Sample of Individuals with Schizophrenia: Validation de la version française de l’instrument d’évaluation des compétences MacArthur-traitement (MacCAT-T) dans un échantillon français de personnes souffrant de schizophrénie

The Canadian Journal of Psychiatry ◽

10.1177/0706743720966443 ◽

2020 ◽

pp. 070674372096644

Author(s):

Stéphane Raffard ◽

Cindy Lebrun ◽

Yasmine Laraki ◽

Delphine Capdevielle

Keyword(s):

Decision Making ◽

Factor Analysis ◽

Assessment Tool ◽

Competence Assessment ◽

Rater Reliability ◽

French Version ◽

Capacity To Consent ◽

Decision Making Capacity ◽

Consent To Treatment ◽

High Degree

Background: Assessing an individual’s capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients’ competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients’ decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia. Method: In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated. Results: The MacCAT-T’s internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of “understanding.” Component 2 included all subparts of “appreciation” and “reasoning” and was therefore labeled “reflexivity.” After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education. Conclusions: The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.

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