Grisso T, Appelbaum P S, Hill-Fotouhi C
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA.
Psychiatr Serv. 1997 Nov;48(11):1415-9. doi: 10.1176/ps.48.11.1415.
The feasibility, reliability, and validity of a new instrument, the MacArthur Competence Assessment Tool-Treatment (MacCAT-T), which was developed for use by clinicians, was tested. The instrument assesses patients' competence to make treatment decisions by examining their capacities in four areas--understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice.
The MacCAT-T and instruments to measure symptom severity were administered to 40 patients recently hospitalized with schizophrenia or schizoaffective disorder and 40 matched subjects in the community without mental illness.
A high degree of ease of use and interrater reliability was found for the MacCAT-T. Overall, the hospitalized patients performed significantly more poorly than the community subjects on understanding and reasoning, although many patients performed as well as community subjects. Poor performance was related to higher levels of some psychiatric symptoms, such as conceptual disorganization, hallucinations, and disorientation.
The MacCAT-T offers a flexible yet structured method with which caregivers can assess, rate, and report patients' abilities relevant for evaluating competence to consent to treatment.
测试一种新工具——麦克阿瑟治疗能力评估工具（MacCAT-T）的可行性、可靠性和有效性，该工具是为临床医生使用而开发的。该工具通过检查患者在四个方面的能力来评估其做出治疗决策的能力，这四个方面包括理解与其病情和推荐治疗相关的信息、对其选择的潜在风险和益处进行推理、认识其处境的性质及其选择的后果，以及表达一种选择。
对40名近期因精神分裂症或分裂情感性障碍住院的患者以及40名社区中匹配的无精神疾病受试者使用了MacCAT-T和测量症状严重程度的工具。
发现MacCAT-T具有高度的易用性和评分者间信度。总体而言，住院患者在理解和推理方面的表现明显比社区受试者差，尽管许多患者的表现与社区受试者相当。表现不佳与某些精神症状的较高水平有关，如概念紊乱、幻觉和定向障碍。
MacCAT-T提供了一种灵活但结构化的方法，护理人员可以用它来评估、评分和报告患者与评估同意治疗能力相关的能力。
