轻度阿尔茨海默病患者同意能力的医生判断的一致性
Consistency of physician judgments of capacity to consent in mild Alzheimer's disease.
作者信息
Marson D C, McInturff B, Hawkins L, Bartolucci A, Harrell L E
机构信息
Department of Neurology, University of Alabama at Birmingham 35294, USA.
出版信息
J Am Geriatr Soc. 1997 Apr;45(4):453-7. doi: 10.1111/j.1532-5415.1997.tb05170.x.
OBJECTIVE
To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults.
DESIGN
Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment.
SETTING
University medical center.
PARTICIPANTS
Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology.
MEASUREMENTS
Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression.
RESULTS
Competency judgements of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 (P < .0001) and differed significantly (P < .0001) from the physician group kappa of .14 (P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgements for the AD group (chi 2 = 63.8, P < .0001) but not for the control group (chi 2 = 4.1, P = 1.00). Within the Ad group, pairwise analyses revealed significant judgment disagreement (P < .01) for seven of the 10 physician pairs.
目的
调查医生对正常老年人和患有痴呆症的老年人同意治疗能力判断的一致性。
设计
对受试者进行标准化的同意能力访谈。医生观看这些访谈的录像带，并对同意治疗的能力做出判断。
地点
大学医学中心。
参与者
接受能力评估的受试者（N = 45）包括16名正常老年对照者和29名轻度阿尔茨海默病（AD）患者。从老年精神病学、老年医学和神经学专业招募了五名有评估痴呆症患者能力经验的医学中心医生。
测量
对受试者回答旨在评估同意治疗能力的标准化同意能力访谈（SCCI）进行录像。对受试者诊断不知情的研究医生分别观看每个SCCI录像带，并做出同意或不同意的判断。使用百分比一致性、kappa和逻辑回归评估医生判断的一致性。
结果
医生对对照组的能力判断显示出高度一致性，但对AD患者的一致性较低。作为一个群体，医生对对照组的判断一致性达到了98%，但对轻度AD患者的判断一致性仅为56%。对照组的医生组kappa为1.00（P <.0001），与AD患者的医生组kappa为0.14（P = 0.44）有显著差异（P <.0001），这表明研究医生在两组中一致判断能力的能力存在实际差异。同样，逻辑回归分析显示AD组医生的判断存在显著差异（卡方 = 63.8，P <.0001），而对照组则没有（卡方 = 4.1，P = 1.00）。在AD组内，成对分析显示10对医生中有7对存在显著的判断分歧（P <.01）。
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