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      Assessment of Healthcare Decision-making Capacity

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          Abstract

          It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.

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          The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis.

          Akira Miyake, Naomi Friedman, Michael J Emerson … (2000)
          This individual differences study examined the separability of three often postulated executive functions-mental set shifting ("Shifting"), information updating and monitoring ("Updating"), and inhibition of prepotent responses ("Inhibition")-and their roles in complex "frontal lobe" or "executive" tasks. One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks: the Wisconsin Card Sorting Test (WCST), Tower of Hanoi (TOH), random number generation (RNG), operation span, and dual tasking. Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another, but are clearly separable. Moreover, structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks. Specifically, WCST performance was related most strongly to Shifting, TOH to Inhibition, RNG to Inhibition and Updating, and operation span to Updating. Dual task performance was not related to any of the three target functions. These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to studying the organization and roles of executive functions. Copyright 2000 Academic Press.
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            A new brief instrument for assessing decisional capacity for clinical research.

            Dilip V. Jeste, Barton W Palmer, Paul Appelbaum … (2007)
            There is a critical need for practical measures for screening and documenting decisional capacity in people participating in different types of clinical research. However, there are few reliable and validated brief tools that could be used routinely to evaluate individuals' capacity to consent to a research protocol. To describe the development, testing, and proposed use of a new practical instrument to assess decision-making capacity: the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). The UBACC is intended to help investigators identify research participants who warrant more thorough decisional capacity assessment and/or remediation efforts prior to enrollment. We developed the UBACC as a 10-item scale that included questions focusing on understanding and appreciation of the information concerning a research protocol. It was developed and tested among middle-aged and older outpatients with schizophrenia and healthy comparison subjects participating in research on informed consent. In an investigation of reliability and validity, we studied 127 outpatients with schizophrenia or schizoaffective disorder and 30 healthy comparison subjects who received information about a simulated clinical drug trial. Internal consistency, interrater reliability, and concurrent (criterion) validity (including correlations with an established instrument as well as sensitivity and specificity relative to 2 potential "gold standard" criteria) were measured. Reliability and validity of the UBACC. The UBACC was found to have good internal consistency, interrater reliability, concurrent validity, high sensitivity, and acceptable specificity. It typically took less than 5 minutes to administer, was easy to use and reliably score, and could be used to identify subjects with questionable capacity to consent to the specific research project. The UBACC is a potentially useful instrument for screening large numbers of subjects to identify those needing more comprehensive decisional capacity assessment and/or remediation efforts.
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              Contextual prerequisites for understanding: Some investigations of comprehension and recall

              John Bransford, Marcia Johnson (1972)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Clin Neuropsychol
                Journal ID (iso-abbrev): Arch Clin Neuropsychol
                Journal ID (publisher-id): acn
                Journal ID (hwp): acn
                Title: Archives of Clinical Neuropsychology
                Publisher: Oxford University Press
                ISSN (Print): 0887-6177
                ISSN (Electronic): 1873-5843
                Publication date (Print): September 2016
                Publication date (Electronic): 30 August 2016
                Volume: 31
                Issue: 6 , Abstracts from the 36th Annual Conference of the National Academy of Neuropsychology Seattle, WA, October 19-22, 2016
                Pages: 530-540
                Affiliations
                [1 ] Department of Psychiatry, University of California , San Diego, CA, USA
                [2 ] Veterans Medical Research Foundation, San Diego, CA, USA
                [3 ] Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
                [4 ] Center for Healthy Aging/Stein Institute for Research on Aging, University of California , San Diego, CA, USA
                [5 ] San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
                Author notes
                [* ]Corresponding author at: University of California, San Diego, 9500 Gilman Drive, MC 0993, La Jolla, CA 92093–0993. Tel.: 858–246-0765; fax: (858) 822-7514. E-mail address: bpalmer@ 123456ucsd.edu (B.W. Palmer).
                Article
                Accession ID: PMC5007079 Pmcid ID: PMC5007079 Pmc-uid ID: 5007079 Publisher ID: acw051
                DOI: 10.1093/arclin/acw051
                PMC ID: 5007079
                PubMed ID: 27551024
                SO-VID: af937e74-d27a-4830-84e8-895f45b60ac9
                Copyright © © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
                History
                Date accepted : 22 June 2016
                Categories
                Subject: Literature Review

                Keywords: Alzheimer's disease,Schizophrenia,Assessment
                Data availability:
                Keywords: Alzheimer's disease, Schizophrenia, Assessment

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