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Cited by 220Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareDementia and Cognitive Impairment Research

Consistency of physician judgments of capacity to consent in mild Alzheimer’s disease

Marson, Daniel C., McInturff, Bronwyn, Hawkins, Lauren, Bartolucci, Alfred, Harrell, Lindy E.·1997·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.1997.tb05170.x
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Abstract

OBJECTIVE: To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults. DESIGN: Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment. SETTING: University medical center. PARTICIPANTS: Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology. MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression. RESULTS: Competency judgments of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 ( P < .0001) and differed significantly ( P < .0001) from the physician group kappa of .14 ( P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgments for the AD group (χ 2 = 63.8, P < .0001) but not for the control group (χ 2 = 4.1, P = 1.00). Within the AD group, pairwise analyses revealed significant judgment disagreement ( P < .01) for seven of the 10 physician pairs. CONCLUSIONS: Experienced physicians demonstrated significant agreement judging the competency of older controls, but significant disagreement judging the competency of mild AD patients. Physician judgment currently does not represent a gold standard for determining consent capacity of dementia patients. Standardized assessment instruments and clinical training may improve the agreement and accuracy of physician competency judgments.

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  • Studies have shown physicians frequently disagree on the competency of psychiatric patients who request assisted death - inter-rater reliability of capacity judgments by clinicians without the aid of standardized assessments is low, and modest evidence suggests clinicians tend to overestimate capacity.

    “Studies have shown physicians frequently disagree on the competency of psychiatric patients who request assisted death — inter-rater reliability of capacity judgments by clinicians without the aid of standardized assessments is low, and modest evidence suggests clinicians tend to overestimate capacity (6, 47–50).”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [49]

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Authors
Marson, D. C., McInturff, B., Hawkins, L., Bartolucci, A., & Harrell, L. E.
Affiliations
University of Alabama at Birmingham (US)
Corresponding author
Marson, Daniel C.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
1997-04
Volume
45
Issue
4
Pages
453-457
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.1997.tb05170.x
OpenAlex
W2089509661
Cited by
220
References
33
Citations by year
2026: 2 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 11 · 2020: 3 · 2019: 7 · 2018: 8 · 2017: 8 · 2016: 5 · 2015: 8 · 2014: 10 · 2013: 11 · 2012: 4
FWCI
12.62
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 6600 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5p01ag006569-13, 5p30ag010163-05)
  • National Institute on Aging (5 PO1 AG06569-05, 1 P30 AG10163-1)
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 › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
capacity to consent, informed consent, Alzheimer's disease, mild dementia, competency assessment, older adults, inter-rater reliability
MeSH terms
Aged, Alzheimer Disease, Decision Making, Geriatric Psychiatry, Geriatrics, Humans, Informed Consent, Interview, Psychological, Judgment, Neurology, Physicians, Observer Variation, Logistic Models, Mental Competency, Consensus, Control Groups

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