Ladwig Sönke, Pauls Franz, Gerke Leonie, Trachsel Manuel, Nestoriuc Yvonne
Department of Clinical Psychology and Psychotherapy, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany.
Clinical Ethics Unit, University Hospital Basel (USB), Basel, Switzerland.
Clin Psychol Psychother. 2023 Nov 22. doi: 10.1002/cpp.2935.
Patients' capacity to consent to treatment (CCT) is a prerequisite for ethically sound informed consent in psychotherapy. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is a reliable instrument for assessing CCT. A German version was adapted to the psychotherapeutical context (MacCAT-PT) to investigate its reliability and possible influences of age, education and prior experience with psychotherapy on CCT in a mixed clinical sample.
N = 108 patients with indication for psychotherapy were recruited. The MacCAT-PT was administered by trained psychologists, took 20 min on average and was rated by the administering psychologist and an independent rater. Reliability statistics were investigated and regression analyses were conducted on MacCAT-PT scores and sociodemographic variables.
Sufficient to moderate inter-rater reliability (ICC = 0.80) and internal consistency (α = 0.80) were found for the total sum score of the MacCAT-PT and its scales, Understanding (ICC = 0.79, α = 0.77), Reasoning (ICC = 0.57, α = 0.65) and Making a Choice (ICC = 0.57). Appreciation featured an unacceptable inter-rater reliability (ICC = -0.01). Regression analyses indicated no significant effects.
These findings suggest that the MacCAT-PT is a reliable tool for assessing patients' overall CCT in psychotherapy. Psychometric properties of three scales were of good quality, while Appreciation needs to be reanalysed in patient samples with lower motivation for psychotherapy or limited CCT. The CCT may be suggested to be independent of age, education and prior experience. Future research should provide analyses focusing on structural and clinical validity in multiple clinical samples.
患者同意治疗的能力（CCT）是心理治疗中符合伦理的知情同意的前提条件。麦克阿瑟治疗能力评估工具（MacCAT-T）是评估CCT的可靠工具。一个德语版本已被改编用于心理治疗背景（MacCAT-PT），以在一个混合临床样本中研究其可靠性以及年龄、教育程度和先前心理治疗经验对CCT的可能影响。
招募了N = 108名有心理治疗指征的患者。MacCAT-PT由经过培训的心理学家进行施测，平均耗时20分钟，并由施测心理学家和一名独立评分者进行评分。研究了信度统计数据，并对MacCAT-PT分数和社会人口统计学变量进行了回归分析。
MacCAT-PT及其量表的总分、理解（ICC = 0.79，α = 0.77）、推理（ICC = 0.57，α = 0.65）和做出选择（ICC = 0.57）的评分者间信度足够到中等（ICC = 0.80），内部一致性（α = 0.80）。评价的评分者间信度不可接受（ICC = -0.01）。回归分析表明没有显著影响。
这些发现表明MacCAT-PT是评估心理治疗中患者总体CCT的可靠工具。三个量表的心理测量特性质量良好，而评价需要在心理治疗动机较低或CCT有限的患者样本中重新分析。CCT可能与年龄、教育程度和先前经验无关。未来的研究应提供针对多个临床样本的结构和临床效度的分析。
