Assessment of competence to complete advance directives: validation of a patient centred approach
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OBJECTIVE: To develop a patient centred approach for the assessment of competence to complete advance directives ("living wills") of elderly people with cognitive impairment. DESIGN: Semistructured interviews. SETTING: Oxfordshire. SUBJECTS: 50 elderly volunteers living in the community, and 50 patients with dementia on first referral from primary care. MAIN OUTCOME MEASURES: Psychometric properties of competence assessment. RESULTS: This patient centred approach for assessing competence to complete advance directives can discriminate between elderly persons living in the community and elderly patients with dementia. The procedure has good interrater (r=0.95) and test-retest (r=0.97) reliability. Validity was examined by relating this approach with a global assessment of competence to complete an advance directive made by two of us (both specialising in old age psychiatry). The data were also used to determine the best threshold score for discriminating between those competent and those incompetent to complete an advance directive. CONCLUSION: A patient centred approach to assess competence to complete advance directives can be reliably and validly used in routine clinical practice.
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The research literature shows consistently that persons even in early stages of dementia are, based on a functional model of capacity, very often or usually incompetent to consent to treatment, to research, or to write an advance treatment directive.
“the research literature that shows consistently that persons even in early stages of dementia are, based on a functional model of capacity, very often or usually incompetent to consent to treatment,(30) to research, (31) or to write an advance treatment directive.(32)”
From Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands (2020) · cites this paper as [32]
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- Authors
- Fazel, S., Hope, T., & Jacoby, R.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Fazel, S.
- ORCID
- Fazel, S.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1999-02-20
- Volume
- 318
- Issue
- 7182
- Pages
- 493-497
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC27742
- OpenAlex
- W1968943466
- Cited by
- 83
- References
- 36
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 2 · 2019: 2 · 2018: 5 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 5 · 2012: 3
- FWCI
- 7.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance directives, living wills, competency assessment, dementia, cognitive impairment, older adults, psychometric validation, inter-rater reliability, test-retest reliability, threshold scores, end-of-life decisions
- MeSH terms
- Dementia, Female, Humans, Male, Surveys and Questionnaires, Sensitivity and Specificity, Living Wills, Mental Competency, Patient-Centered Care, Personal Autonomy
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