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Cited by 54Healthcare Decision-Making and RestraintsEthics in Clinical ResearchEthics and bioethics in healthcare

Prevalence and correlates of adequate performance on a measure of abilities related to decisional capacity: Differences among three standards for the MacCAT-CR in patients with schizophrenia

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Dunn, Laura B., Palmer, Barton W., Appelbaum, Paul S., Saks, Elyn R., Aarons, Gregory A., Jeste, Dilip V.·2007·Schizophrenia Research
DOI 10.1016/j.schres.2006.08.005PMC PMC1850805
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Abstract

Despite the availability of structured decision-making capacity assessment tools, insufficient guidance exists for applying their results. Investigators often use cutpoints on these instruments to identify potential subjects in need of further assessment or education. Yet, information is lacking regarding the effects of different cutpoints on the proportion and characteristics of individuals categorized as possessing adequate or impaired decisional abilities for consent to research. To demonstrate the potential impact of different standards, we informed 91 individuals, aged 50 or older with a diagnosis of schizophrenia or schizoaffective disorder, about a hypothetical clinical trial, and assessed their decisional abilities with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Three published MacCAT-CR-based standards were applied to participants' scores to examine the rates and correlates of categorical determinations of adequate performance. The three standards ranged in stringency: the most stringent incorporated cutpoints on all three of the major MacCAT-CR subscales (Understanding, Appreciation, and Reasoning); the other two standards required threshold performance only on the Understanding subscale. The most stringent standard resulted in a 57% rate of impaired performance; the intermediate standard, 19%; and the least stringent standard, 8%. Nearly half of the participants (n=45) were classified as having performed adequately by the least stringent standard yet inadequately by the most stringent. The majority of these 45 were impaired on the Appreciation subscale (n=9), Reasoning (n=15), or both (n=18). Cognitive functioning was correlated with performance status for the more stringent standards. These findings underscore the need for refinement of capacity assessment procedures and for improvements in the use of capacity assessment tools for screening purposes and to assist in categorical capacity determinations.

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  • Other studies of arbitrary cut-off points using the MacCAT-CR found consistent effects.

    “This is consistent with other studies of the effect of arbitrary cut-off points using the MacCAT-CR which assesses capacity to decide upon participation in research (Dunn et al., 2007).”

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

  • Inter-rater disagreements are more likely when the patient's capacity is fluctuating or borderline.

    “Finally, previous studies have also noted that inter-rater disagreements are more likely when the patient's capacity is fluctuating or borderline (Dunn et al., 2007) and that these cases are among the most challenging to assess (Ariyo et al., 2021).”

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

    The Methods (section 2.3.2; page unavailable) report overall inter-rater reliability, while the Discussion (section 4; page unavailable) describes a gray zone in which classifications differ across assessment standards—not across raters. Our copy does not assess whether inter-rater disagreements are more likely when capacity is fluctuating or borderline; searches for those terms found no such analysis. (LLM, conf=0.75)

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Research works printed but not linked: 1

  1. Kongs S, Thompson L, Iverson G, et al. Professional Manual. Psychological Assessment Resources, Inc.; Odessa, FL: 2000. Wisconsin Card Sorting Test-64 Card Version. [Google Scholar]

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Authors
Dunn, L. B., Palmer, B. W., Appelbaum, P. S., Saks, E. R., Aarons, G. A., & Jeste, D. V.
Affiliations
  • University of California San Diego (US)
  • Columbia University (US)
  • University of Southern California (US)
Corresponding author
Dunn, Laura B.
ORCID
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2007-01
Volume
89
Issue
1-3
Pages
110-118
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/j.schres.2006.08.005
PMC
PMC1850805
OpenAlex
W2117372401
Cited by
54
References
52
Citations by year
2024: 6 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 6 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 6 · 2014: 2 · 2013: 3 · 2012: 1
FWCI
3.32
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Schizophrenia Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of California, San Diego
  • Veterans Affairs San Diego Healthcare System
  • National Institute of Mental Health (MH 66248, MH-66062, R01MH064722, K23MH066062, P30MH066248, MH 64722)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
decision-making capacity
MeSH terms
Aged, Aptitude, Clinical Trials as Topic, Cross-Sectional Studies, Decision Making, Female, Humans, Informed Consent, Male, Middle Aged, Neuropsychological Tests, Problem Solving, Psychometrics, Psychotic Disorders, Reference Standards, Schizophrenia, Schizophrenic Psychology, Statistics as Topic, Reproducibility of Results, Mental Competency, Patient Selection, Comprehension

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