Etchells E, Katz M R, Shuchman M, Wong G, Workman S, Choudhry N K, Craven J, Singer P A
Department of Medicine, Toronto Hospital, Ontario, Canada.
Psychosomatics. 1997 May-Jun;38(3):239-45. doi: 10.1016/s0033-3182(97)71460-9.
The authors evaluated the accuracy of clinical impressions and Mini-Mental State Exam scores for assessing patient capacity to consent to major medical treatment, relative to expert psychiatric assessment. Consecutive medical inpatients (N = 63) facing a decision about major medical treatment received a clinical impression of capacity from their treating physician and the Standardized Mini-Mental State Exam (SMMSE); 48 received independent psychiatric assessment of capacity. Analyses revealed that both clinical impressions and SMMSE scores were generally inaccurate in determining capacity, although all 23 participants with a clinical impression of "definitely capable" were found capable by the psychiatrist. Given the importance of assessing capacity to consent to major medical treatment, better approaches to the clinical assessment of capacity are required. Several strategies are discussed.
作者评估了临床判断和简易精神状态检查表得分在评估患者对重大医疗治疗同意能力方面的准确性，并与专家精神病学评估进行了对比。连续63名面临重大医疗治疗决策的住院患者接受了主治医生对其同意能力的临床判断以及标准化简易精神状态检查表（SMMSE）评估；48名患者接受了独立的精神病学同意能力评估。分析表明，临床判断和SMMSE得分在确定同意能力方面通常不准确，不过所有23名被临床判断为“肯定有能力”的参与者经精神病医生评估也被认定有能力。鉴于评估对重大医疗治疗同意能力的重要性，需要更好的临床能力评估方法。文中讨论了几种策略。
