Assessing Medical Decision-Making Capacity

Research has shown that many clinicians lack formal training in evaluating medical decision-making capacity. Typically, patients who may lack capacity are evaluated only when decisions to be made are complex and have significant risks or if patients disagree with physician recommendations. The standards for medical decision-making capacity vary, but require patients to have the ability to: 1) Understand relevant information about proposed diagnostic tests or treatment. 2) Appreciate their situation. 3) Use reason to make decisions. 4) Communicate their choice. “All licensed physicians can make a determination of incapacity, but most lack the training, experience, and confidence to do so,” says Laura L. Sessums, JD, MD. “Capacity evaluations could benefit from utilizing a standardized approach. Physicians may perform these evaluations more frequently if they have a useful instrument to guide these assessments.” Intriguing New Research on Capacity Ideally, clinical tools for evaluating capacity should be brief, reliable, and facilitate the documentation of capacity abilities. Many instruments have been developed for assessing capacity to make medical decisions, but most have not been validated in high-quality studies. In the July 27, 2011 JAMA, Dr. Sessums and colleagues conducted a study to determine the prevalence of incapacity and assess the utility of available instruments for capacity evaluation in adult medicine patients without severe mental illnesses. “Our goal was to provide a guide for clinicians to select a valid, reliable, and clinically useful tool for assessing and documenting incapacity in their own patients,” she says. The analysis showed that the overall prevalence of incapacity among healthy older adults was 2.8%, but the rate of incapacity increased substantially with higher degrees of morbidity (Table...