A 75-year-old woman has type 2 diabetes mellitus, peripheral vascular disease, and a gangrenous ulcer of her left foot. A below-the-knee amputation is recommended, but she declines, saying that she has lived long enough and wants to die with her body intact. Her internist is concerned about her increasing confusion over the past year and notes that she appears to be depressed. How should her physician determine whether her decision is competent?

https://www.bumc.bu.edu/im-residency/files/2013/03/Capacity.pdf

Assessment of Patients' Competence to Consent to Treatment

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC. Methods: Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, ...

https://www.thyca.org/download/document/185/ATCGuidelines2012.pdf

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

Objective: The need to evaluate decisional capacity among patients in treatment settings as well as subjects in clinical research settings has increasingly gained attention. Decisional capacity is generally conceptualized to include not only an understanding of disclosed information but also an appreciation of its significance, the ability to use the information in reasoning, and the ability to express a clear choice. The authors critically reviewed existing measures of decisional capacity for research and treatment. Method: Electronic medical and legal databases were searched for articles published from 1980 to 2004 describing structured assessments of adults’ capacity to consent to clinical treatment or research protocols. The authors identified 23 decisional capacity assessment instruments and evaluated each in terms of format, content, administration features, and psychometric properties. Results: Six instruments focused solely on understanding of disclosed information, and 11 tested for understanding...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.2006.163.8.1323

Assessing decisional capacity for clinical research or treatment: a review of instruments.

Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English-speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.

https://accpjournals.onlinelibrary.wiley.com/doi/pdf/10.1592/phco.22.5.282.33191

Health Literacy: A Review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(04)17224-3.pdf

Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study

OBJECTIVE: To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment.

/pdf/assessment-of-patient-capacity-to-consent-to-treatment-3qmufiev4c.pdf

Assessment of Patient Capacity to Consent to Treatment

Assessment of patient capacity to consent to treatment

The Aid to Capacity Evaluation is conducted to determine a person’s ability to make informed decisions regarding his/her treatment and/or authorization to release confidential information. Persons served by Henrico Area Mental Health & Retardation Services are presumed capable of making decisions unless proven otherwise through this evaluation. Prior to conducting the evaluation, a staff member involved in the person’s care (doctor, case manager, occupational therapist) should explain the treatment or action and its risks, benefits and alternative treatments, if any. The evaluating clinician/case manager should also understand the treatment, so as to judge whether the person’s response is accurate. The evaluator should assure that the treatment has been explained to the consumer, using an appropriate communication method (e.g., sign language). If the evaluator feels that an adequate explanation has not been given, he/she may offer a brief explanation (see Guidelines) prior to conducting the Capacity Evaluation.

Julia McKenny

Papers

Assessment of Patient Capacity to Consent to Treatment

Assessment of patient capacity to consent to treatment

Aid to Capacity Evaluation