Assessing capacity to consent to treatment with cholinesterase inhibitors in dementia using a specific and standardized version of the MacArthur Competence Assessment Tool (MacCAT-T)

2016 ◽  
Vol 29 (2) ◽  
pp. 333-343 ◽  
Author(s):  
Tanja Mueller ◽  
Julia Haberstroh ◽  
Maren Knebel ◽  
Frank Oswald ◽  
Roman Kaspar ◽  
...  
Keyword(s):  
Informed Consent ◽  
Cholinesterase Inhibitors ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Competence Assessment ◽  
Rater Reliability ◽  
Capacity To Consent ◽  
People With Dementia ◽  
Hypothetical Treatment ◽  
Consent To Treatment

ABSTRACTBackground:The use of assessment tools has been shown to improve the inter-rater reliability of capacity assessments. However, instrument-based capacity assessments of people with dementia face challenges. In dementia research, measuring capacity with instruments like the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) mostly employ hypothetical treatment vignettes that can overwhelm the abstraction capabilities of people with dementia and are thus not always suitable for this target group. The primary aim of this study was to provide a standardized real informed consent paradigm that enables the dementia-specific properties of capacity to consent to treatment in people with dementia to be identified in a real informed consent process that is both externally valid and ethically justifiable.Methods:The sample consisted of 53 people with mild to moderate dementia and a group of 133 people without cognitive impairment. Rather than using a hypothetical treatment vignette, we used a standardized version of the MacCAT-T to assess capacity to consent to treatment with cholinesterase inhibitors in people with dementia. Inter-rater reliability, item statistics, and psychometric properties were also investigated.Results:Intraclass correlations (ICCs) (0.951–0.990) indicated high inter-rater reliability of the standardized real informed consent paradigm. In the dementia group, performance on different items of the MacCAT-T varied. Most people with dementia were able to express a treatment choice, and were aware of the need to take a tablet. Further information on the course of the disorder and the benefits and risks of the treatment were less understood, as was comparative reasoning regarding treatment alternatives.Conclusion:The standardized real informed consent paradigm enabled us to detect dementia-specific characteristics of patients’ capacity to consent to treatment with cholinesterase inhibitors. In order to determine suitable enhanced consent procedures for this treatment, we recommend the consideration of MacCAT-T results on an item level. People with dementia seem to understand only basic information. Our data indicate that one useful strategy to enhance capacity to consent is to reduce attention and memory demands as far as possible.

scholarly journals 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

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.

scholarly journals Can the Mini-Mental State Examination Predict Capacity to Consent to Treatment?

GeroPsych ◽  
2014 ◽  
Vol 27 (4) ◽  
pp. 151-159 ◽  
Author(s):  
Julia Haberstroh ◽  
Tanja Müller ◽  
Maren Knebel ◽  
Roman Kaspar ◽  
Frank Oswald ◽  
...  
Keyword(s):  
Mental State ◽  
Mini Mental State Examination ◽  
Assessment Tool ◽  
Equation Modeling ◽  
Modeling Framework ◽  
Capacity To Consent ◽  
People With Dementia ◽  
Consent To Treatment ◽  
The Relationship ◽  
State Examination

This study examines the relationship between capacity to consent to treatment as measured by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and severity of cognitive impairment as measured with the Mini-Mental State Examination (MMSE). It also looks at the role of verbal retrieval in this relationship. We hypothesized that the often-quoted correlation between the MacCAT-T and the MMSE lies mainly in the joint dependence on verbal retrieval ability. Potential subjects were recruited from memory clinics, senior citizen meeting places, and a university program for seniors. Data of 149 people over 54 years, 49 of whom had been diagnosed with Alzheimer’s disease or mixed dementia, were used. The relationship between capacity to consent to treatment, verbal retrieval, and MMSE was examined using a structural equation modeling framework. The findings suggest that verbal retrieval is a confounding method factor. In the informed consent process for people with dementia, verbal memory loads should be minimized to provide a more valid measure of their capacity to consent to treatment.

scholarly journals Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis

2021 ◽  
pp. 1-14
Author(s):  
Giovanna Parmigiani ◽  
Antonio Del Casale ◽  
Gabriele Mandarelli ◽  
Benedetta Barchielli ◽  
Georgios D. Kotzalidis ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Competence Assessment ◽  
Decisional Capacity ◽  
Capacity To Consent ◽  
Decision Making Capacity ◽  
Consent To Treatment

ABSTRACT Objectives: To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD), and healthy comparisons (HCs). Design: A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases. Setting: The United States, France, Japan, and China. Participants: Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included. Measurements: The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC). Results: We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD. Conclusions: Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent.

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

2019 ◽  
Vol 59 (4) ◽  
pp. 247-254 ◽  
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.

scholarly journals How Do We Assess Patient Skills in a Competence-Based Program? Assessment of Patient Competences Using the Spanish Version of the Prolapse and Incontinence Knowledge Questionnaire and Real Practical Cases in Women with Pelvic Floor Disorders

2021 ◽  
Vol 18 (5) ◽  
pp. 2377
Author(s):  
Beatriz Sánchez-Sánchez ◽  
Beatriz Arranz-Martín ◽  
Beatriz Navarro-Brazález ◽  
Fernando Vergara-Pérez ◽  
Javier Bailón-Cerezo ◽  
...  
Keyword(s):  
Decision Making ◽  
Pelvic Floor ◽  
Discriminant Validity ◽  
Pelvic Floor Disorders ◽  
Assessment Tool ◽  
Pelvic Organ ◽  
Assessment Tools ◽  
Measurement Properties ◽  
Competence Assessment ◽  
Knowledge Questionnaire

Therapeutic patient education programs must assess the competences that patients achieve. Evaluation in the pedagogical domain ensures that learning has taken place among patients. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a tool for assessing patient knowledge about urinary (UI) and pelvic organ prolapse (POP) conditions. The aim of this study was to translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Spanish and test its measurement properties, as well as propose real practical cases as a competence assessment tool. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Measurement properties analysis was performed by assessing the validity, reliability, responsiveness, and interpretability. A total of 275 women were recruited. The discriminant validity showed statistically significant differences in the PIKQ scores between patients and expert groups. Cronbach’s alpha revealed good internal consistency. The test–retest reliability showed excellent correlation with UI and POP scales. Regarding responsiveness, the effect size, and standardized response mean demonstrated excellent values. No floor or ceiling effects were shown. In addition, three “real practical cases” evaluating skills in identifying and analyzing, decision making, and problem-solving were developed and tested. The Spanish PIKQ is a comprehensible, valid, reliable, and responsive tool for the Spanish population. Real practical cases are useful competence assessment tools that are well accepted by women with pelvic floor disorders (PFD), improving their understanding and their decision-making regarding PFD.

Assessing the Internal Reliability and Construct Validity of the General Movement Competence Assessment for Children

2020 ◽  
Vol 8 (1) ◽  
pp. 87-106 ◽  
Author(s):  
Jonathan Leo Ng ◽  
Chris Button ◽  
Dave Collins ◽  
Susan Giblin ◽  
Gavin Kennedy
Keyword(s):  
Assessment Tool ◽  
Dynamic Environment ◽  
Principal Component ◽  
Internal Consistency Reliability ◽  
Assessment Tools ◽  
Microsoft Kinect ◽  
Competence Assessment ◽  
Factorial Structure ◽  
Internal Reliability ◽  
General Movement

Validated assessment tools for movement competence typically involve the isolation and reproduction of specific movement forms, which arguably neglects individuals’ ability to combine and adapt movements to overcome constraints within a dynamic environment. A new movement assessment tool, the General Movement Competence Assessment (GMCA), was developed for this study using Microsoft Kinect. Movement competence of 83 children (36 boys and 47 girls), aged 8–10 years (9.06 ± 0.75 years) was measured using the GMCA. An exploratory approach was undertaken to examine the internal consistency reliability (McDonald’s omega coefficient) and factorial structure of the GMCA for the study sample. Factorial structure was determined using exploratory factor analysis by principal component analysis with varimax rotation. For the sample data, reliability for the GMCA games were acceptable (ω = 0.53–0.89) and indicated that combinations of movement attributes were measured by GMCA games. Factorial analysis extracted four movement constructs accounting for 71.31% of variance. Dexterity was tentatively identified as a new independent construct alongside currently accepted movement constructs (i.e., locomotion, object-control, stability). While further development of the GMCA is still required, initial results are encouraging in view of an objective and theoretically informed approach to assess general movement competence in children.

scholarly journals Cognitive and functional dementia assessment tools: Review of Brazilian literature

2007 ◽  
Vol 1 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Luciano Góis Vasconcelos ◽  
Sonia Maria Dozzi Brucki ◽  
Orlando Francisco Amodeo Bueno
Keyword(s):  
Normative Data ◽  
Formal Education ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Functional Evaluation ◽  
Brazilian Literature ◽  
Assessment Tests ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
Independent Effects

Abstract The diagnosis of dementia is based on cognitive and functional evaluation. One of the difficulties in ascertaining the number of people with dementia in developing countries is the population's lack of formal education. Independent effects of age, sex and education have been identified on scores for most but not all cognitive tests. Objectives: Identify the most-used cognitive and functional assessment tools in Brazil, related to dementia diagnosis and treatment outcome; and identify adaptations or normative data, when available. Methods: Data were generated from PubMed, LILACS and Portal Periodicos CAPES (thesis database) databases using the search terms 'dementia' and 'Alzheimer'. Data collection criteria were a. Articles with abstract; b. Brazilian abstracts, related to adult Brazilian population; c. Clear mention of assessment tool in the abstract text. A total of 108 abstracts were selected for the main analysis: a. to identify the instruments used b. to determine how many of the selected abstracts mentioned each tool and c. to search in the mentioned databases for respective test adaptations or normative data. Results: Some 52 different assessment tools, 41 cognitive instruments and 11 functional instruments were identified. The most cited assessment tests were the Mini Mental State Examination (64 abstracts) and Pfeffer Functional Activities Questionnaire (4 abstract). Discussion: Many of the instruments used only have the description of the translation process into Portuguese, along with some suggestions of validation or normative data. Few of these followed the recommended procedures of validation, replication, normalization or transcultural adaptation.

scholarly journals The development and testing of the dementia friendly communities environment assessment tool (DFC EAT)

2016 ◽  
Vol 29 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Richard Fleming ◽  
Kirsty Bennett ◽  
Terri Preece ◽  
Lyn Phillipson
Keyword(s):  
Assessment Tool ◽  
Internal Validity ◽  
Commercial Buildings ◽  
Town Planning ◽  
Environmental Audit ◽  
Audit Tool ◽  
Rater Reliability ◽  
Medical Centers ◽  
People With Dementia ◽  
Medical Facilities

ABSTRACTBackground:There is a growing recognition of the need to make the built environment in towns and cities more enabling for people with dementia. This study reports the development of a reliable tool to assess the support provided to people with dementia by public and commercial buildings such as council offices, supermarkets, banks, and medical centers as they approach, use, and leave them.Methods:A three-step process was carried out to develop and establish the reliability of the tool: (1) a review of principles and available tools informed the development and modification of an environmental audit tool of proven utility, (2) the draft tool was subjected to an iterative process of evaluation by a team of people with expertise in design and town planning, people with dementia and their carers, (3) inter-rater reliability and internal consistency were assessed on a sample of 60 public and commercial buildings.Results:The review of available tools led to the drafting of a tool that was refined through iterative, experience-based evaluation resulting in a tool that has high inter-rater reliability and internal validity. The data gathered enabled a sample of banks, libraries, shops, medical facilities, supermarkets and council offices to be compared.Conclusions:The new tool aids the collection of reliable information on the strengths and weaknesses of public and commercial buildings. This information is likely to be of use in the refurbishment of these buildings to improve their support of people with dementia as they use them in their daily life.

Review of Food Intake Difficulty Assessment Tools for People with Dementia

2020 ◽  
pp. 019394592097966
Author(s):  
Jia Ci Spencer ◽  
Riris Damanik ◽  
Mu-Hsing Ho ◽  
Jed Montayre ◽  
Victoria Traynor ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Assessment Tools ◽  
Future Research ◽  
Research Needs ◽  
Validity And Reliability ◽  
Rater Reliability ◽  
Feeding Difficulties ◽  
People With Dementia ◽  
Feeding Difficulty ◽  
Difficulty Index

This review aimed to summarise the validity and reliability of feeding difficulties assessment tools for Individual with dementia. PubMed, PsycINFO, MEDLINE, CINAHL and Scopus were searched for feeding difficulty measurements studies published between 1990 and 2019. Sixteen publications were included and identified three tools: Edinburgh Feeding Evaluation in Dementia (EdFED), Feeding Behaviour Inventory (FBI), and Feeding Difficulty Index (FDI). Results showed the EdFED was translated and tested in various languages. The EdFED and FDI demonstrated high content and construct validity. The FBI was not validated. The EdFED had high inter-rater reliability, with Cronbach’s alpha ranging from 0.75 to 0.90. The FDI and FBI showed moderate inter-rater reliability. Although the EdFED has been tested and widely used, unlike FDI, which addresses multi-aspects of feeding difficulty. The FDI have higher clinical utility but future research needs to test the psychometric properties of FDI to determine its effectiveness in assessing feeding difficulties.

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