McSwiggan Sally, Meares Susanne, Porter Melanie
Department of Psychology,Macquarie University,North Ryde,Australia.
Int Psychogeriatr. 2016 Mar;28(3):373-84. doi: 10.1017/S1041610215001490. Epub 2015 Sep 28.
Evidence of impaired decision-making capacity is a legal requirement for adult guardianship. To understand the quality of the evidence health professionals commonly provide in reports submitted to guardianship courts, a systematic review was undertaken to appraise the design and methodological quality of the published literature on health professionals' written reports of decision-making capacity and to describe the content of these reports.
Electronic searches from 1980 to 2015 identified 1183 articles of which 11 met the inclusion criteria where each evaluated quantitatively the content of health professionals' written reports submitted to adult guardianship proceedings. Methodological quality of the selected studies was rated using a critical appraisal tool.
Nine studies sourced files from courts in the U.S. and one from Sweden; another reported on guardianship decisions from Australia. Four studies were rated as moderately strong or strong. Strengths included the use of comparison groups and a reliable and valid instrument to code reports. The review showed a person's medical condition was often cited as evidence of impaired decision-making capacity. Cognitive, psychiatric and functional abilities were less often described, and a person's values and preferences were rarely recorded.
It is recommended health professionals describe the process by which a person makes a particular decision (their ability to understand, appreciate, reason and communicate) in addition to providing medical information, including cognitive, psychiatric and functional abilities. This approach provides support for a professional's opinion and evidence for a court. International studies of health professionals' approach to decision-making capacity evaluation are needed.
决策能力受损的证据是成人监护的法律要求。为了解健康专业人员在提交给监护法庭的报告中通常提供的证据质量，进行了一项系统综述，以评估已发表文献中关于健康专业人员决策能力书面报告的设计和方法质量，并描述这些报告的内容。
对1980年至2015年的电子检索共识别出1183篇文章，其中11篇符合纳入标准，每篇文章都对提交给成人监护程序的健康专业人员书面报告的内容进行了定量评估。使用批判性评估工具对所选研究的方法质量进行评分。
9项研究的文件来自美国的法庭，1项来自瑞典；另一项报告了澳大利亚的监护决定。4项研究被评为中等强度或高强度。优点包括使用对照组以及可靠有效的工具对报告进行编码。综述表明，一个人的医疗状况经常被引为决策能力受损的证据。认知、精神和功能能力较少被描述，一个人的价值观和偏好很少被记录。
建议健康专业人员除提供包括认知、精神和功能能力在内的医疗信息外，还应描述一个人做出特定决定的过程（其理解、领会、推理和沟通的能力）。这种方法为专业人员的意见提供了支持，并为法庭提供了证据。需要对健康专业人员评估决策能力的方法进行国际研究。
