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

作者：Owen Gareth S^*; Szmukler George; Richardson Genevra; David Anthony S; Raymont Vanessa; Freyenhagen Fabian; Martin Wayne; Hotopf Matthew

来源：The British Journal of Psychiatry, 2013, 203(6): 461-467.

DOI：10.1192/bjp.bp.112.123976

Background %26lt;br%26gt;Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? %26lt;br%26gt;Aims %26lt;br%26gt;To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. %26lt;br%26gt;Method %26lt;br%26gt;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. %26lt;br%26gt;Results %26lt;br%26gt;Most people scoring low on %26apos;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%26lt;0.001). Appreciation was a better %26apos;test%26apos; of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P%26lt;0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02). %26lt;br%26gt;Conclusions %26lt;br%26gt;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.

• 出版日期2013-12