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Cited by 55Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareEthics in Clinical Research

Assessment of Capacity to Consent to Treatment: Challenges, the “ACCT” Approach, Directions

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Moye, Jennifer, Karel, Michele J., Edelstein, Barry, Hicken, Bret, Armesto, Jorge C., Gurrera, Ronald J.·2007·Clinical Gerontologist
DOI 10.1080/07317110802072140PMC PMC3074108
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Abstract

OBJECTIVE: To review approaches to assessing consent capacity in patients with neurocognitive or neuropsychiatric illness; to summarize the rationale behind our structured interview for consent capacity; and to outline questions for future research. METHOD: After reviewing legal and clinical literature, and empirically comparing three leading consent capacity instruments, we developed the Assessment of Capacity to Consent to Treatment (ACCT) interview and administered it to adults with dementia (n=20), schizophrenia (n=20), and controls (n=19). Capacity ratings by primary care clinicians and experts blind to the patients' status were obtained for a subsample. RESULTS: Interscorer reliability was r=.90; internal consistency reliability was .α=96. ACCT scores agreed 82% of the time (kappa = .44; p<.01) with primary care clinician ratings of capacity and 75% of the time (kappa = .50; p<.05) with expert ratings of capacity. Patients with dementia and schizophrenia could express treatment choices but performed worse than controls on measures of understanding, appreciation as problems with foresight, rational reasoning, and values-based reasoning. Only patients with schizophrenia performed worse on a measure of appreciation as problems with distrust. CONCLUSION: The method of assessing consent capacity described here has adequate reliability and validity, and may provide a useful starting point for clinicians and researchers. Many questions remain about the nature of consent capacity, its component constructs, and the meaning of instrument versus clinician ratings of capacity. Future adaptations, particularly in the assessment of appreciation and reasoning, and additional studies in more diverse samples, are needed.

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  • Moye et al. (2007) concluded that 80% of psychiatric patients lacked the ability to decide between two hypothetical treatment options.

    “They concluded that 80% of psychiatric patients lacked the ability to decide between two hypothetical treatment options.”

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

    The Results (Capacity Ratings; page unavailable) report that 80% of patients with schizophrenia were rated as lacking capacity on Vignette 3. The Methods (Vignettes; page unavailable) describe that vignette as a choice between two hypothetical treatments. The claim overgeneralizes this finding to psychiatric patients as a whole; the rating concerned decision-making capacity, not an inability to state a choice. (LLM, conf=0.88)

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Research works printed but not linked: 7

  1. Appelbaum PS, Grisso T. Manual for Perceptions of Disorder. Worcester, MA: University of Massachusetts Medical School; 1992. [Google Scholar]
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Authors
Moye, J., Karel, M. J., Edelstein, B., Hicken, B., Armesto, J. C., & Gurrera, R. J.
Affiliations
  • Harvard University (US)
  • West Virginia University (US)
  • George E. Wahlen Department of VA Medical Center (US)
ORCID
Venue
Clinical Gerontologist
Publisher
Informa UK Limited
Published
2007-03-03
Volume
31
Issue
3
Pages
37-66
ISSN
  • 0731-7115 (ISSN-L)
  • 1545-2301
DOI
10.1080/07317110802072140
PMC
PMC3074108
OpenAlex
W2073724147
Cited by
55
References
42
Citations by year
2026: 1 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 5 · 2018: 2 · 2017: 5 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 3
FWCI
1.45
Type
journal article
Language
en
Open access
Locations
  • Clinical Gerontologist (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (T32AG023480, P30AG028717)
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
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
Keywords
capacity to consent, informed consent, dementia, schizophrenia, neurocognitive disorders, neuropsychiatric disorders, structured interviews, rational thinking, clinician ratings

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