University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCE-UC), Coimbra, Portugal.
University of Coimbra, Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCE-UC), Coimbra, Portugal.
Psychiatr Q. 2022 Mar;93(1):35-53. doi: 10.1007/s11126-020-09867-7. Epub 2021 Jan 2.
The prevalence of neurodegenerative diseases has been significantly increasing in the last decades, and it is expected to continue to grow. These health disorders can impair patients' decision-making capacity in healthcare. The capacity to make healthcare decisions is a fundamental pillar of informed consent, therefore, it should be carefully assessed. Clinicians' assessment, when not supported by a standardized tool, has revealed to be unreliable, so the recourse to an instrument of capacity assessment is crucial. The present paper aims to identify and summarize published instruments of healthcare decision-making capacity. To do so, a search of peer-reviewed articles in English, Portuguese and Spanish was conducted. A total of eighteen articles, detailing seventeen assessment instruments were selected. Instruments differ on format, structure, assessed abilities and psychometric properties. Likewise, instruments' targeted population also varies, with a few being specifically developed for patients with dementia. Although a high number of instruments were found, there is still no gold standard for healthcare decision-making capacity assessment. The lack of a gold standard highlights the need for more research in this field, as well as an effort to develop guidelines and normative data, in order to improve clinical practices.
在过去几十年中，神经退行性疾病的患病率显著增加，预计这一趋势还将继续。这些健康障碍可能会损害患者在医疗保健方面的决策能力。决策能力是知情同意的重要基础，因此应仔细评估。当临床医生的评估未得到标准化工具支持时，其结果已被证明不可靠，因此，需要使用能力评估工具。本文旨在识别和总结已发表的医疗保健决策能力评估工具。为此，对英语、葡萄牙语和西班牙语的同行评议文章进行了检索。共选择了十八篇文章，详细介绍了十七种评估工具。这些工具在格式、结构、评估能力和心理测量特性上存在差异。同样，工具的目标人群也存在差异，其中一些是专门为痴呆症患者开发的。尽管发现了大量的工具，但在医疗保健决策能力评估方面仍没有金标准。缺乏金标准突出表明，需要在这一领域进行更多的研究，并努力制定指南和规范数据，以改善临床实践。
