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Cited by 38Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareReliability and Agreement in Measurement

The inter-rater reliability of mental capacity assessments

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Raymont, Vanessa, Buchanan, Alec, David, Anthony S., Hayward, Peter, Wessely, Simon, Hotopf, Matthew·2007·International Journal of Law and Psychiatry
DOI 10.1016/j.ijlp.2005.09.006PMC PMC7611629
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Abstract

Background Assessing mental capacity involves complex judgements, and there is little available information on inter-rater reliability of capacity assessments. Assessment tools have been devised in order to offer guidelines. We aimed to assess the inter-rater reliability of judgements made by a panel of experts judging the same interview transcripts where mental capacity had been assessed.Method We performed a cross sectional study of consecutive acute general medical inpatients in a teaching hospital. Patients had a clinical interview and were assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and Thinking Rationally About Treatment (TRAT), two capacity assessment interviews. The assessment was audiotaped and transcribed. The raters were asked to judge whether they thought that the patient had mental capacity based on the transcript. We then divided participants into three groups - those in whom there was unanimous agreement that they had capacity; those in whom there was disagreement; and those in whom there was unanimous agreement that they lacked capacity.Results We interviewed 40 patients. We found a high level of agreement between raters' assessments (mean kappa=0.76). Those thought unanimously to have capacity were more cognitively intact, more likely to be living independently and performed consistently better on all subtests of the two capacity tools, compared with those who were unanimously thought not to have capacity. The group in whom there was disagreement fell in between.Conclusions This study indicates that clinicians can rate mental capacity with a good level of consistency.

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  • Capacity assessments for treatment decisions have strong test-retest reliability.

    “As noted by Cairns et al., 2005 andRaymont et al., 2007, the latter also suggests strong test-retest reliability.”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Raymont et al., 2007

    The Discussion says the study used a single transcribed interview and could not assess reliability across interviews at different times; the authors planned a further study to test that. Its finding of consistent judgments concerns agreement between raters, not test-retest reliability. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. Raymont V Bingley W Buchanan A David AS Hayward P Wessely S The prevalence and associations of mental incapacity in medical in-patients Lancet 2004 364 1421 1427 15488217

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Authors
Raymont, V., Buchanan, A., David, A. S., Hayward, P., Wessely, S., & Hotopf, M.
Affiliations
  • King's College London (GB)
  • Yale University (US)
Corresponding author
Hotopf, Matthew
ORCID
Venue
International Journal of Law and Psychiatry
Publisher
Elsevier BV
Published
2007-03
Volume
30
Issue
2
Pages
112-117
ISSN
0160-2527 (ISSN-L)
DOI
10.1016/j.ijlp.2005.09.006
PMC
PMC7611629
OpenAlex
W2068574634
Cited by
38
References
18
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 6 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 1
FWCI
1.84
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Law and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
Wellcome Trust (069666)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
Keywords
mental capacity assessment, inter-rater reliability, decision-making capacity, cognitive function
MeSH terms
Cardiovascular Diseases, Cognition Disorders, Cross-Sectional Studies, Female, Health Status, Humans, Judgment, Male, Middle Aged, Surveys and Questionnaires, Respiratory Tract Infections, Observer Variation

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