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Cited by 6Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareHealth, Medicine and Society

Developing a Tool to Assess Competency to Consent to Psychiatric Hospitalization (KATOC): Reliability and Validity

Open access
Seo, Mi Kyung, Kim, Seung Hyun, Rhee, MinKyu·2011·Psychiatry Investigation
DOI 10.4306/pi.2011.8.1.39PMC PMC3079184
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Abstract

OBJECTIVE: The justification of informed consent requires that a patient be provided with the information necessary for deciding treatment and able to use such information based on reasonable thinking. The clinical decision to consider anyone who has mental disorder as incompetence without objective assessment does not only encroach human rights of the persons with mental illness, but seriously prevent them from being recovered. Hence the objective assessment of competency is needed in mental health. Our study aimed to develop the Korean Tool of Competency to Consent to Psychiatric Hospitalization and to analyze the reliability and validity of this tool. METHODS: Totally 98 patients with mental illness who were hospitalized in mental hospital, participated in this study. For the subjects a questionnaire composing of 22 questions of understanding, appreciation, reasoning and expression of a choice was used. To investigate validity of this tool, MMSE-K, insight test, estimated IQ, BPRS were conducted. Its reliability and usefulness were examined with Cronbach's alpha, ICC and ROC analysis respectively and criterion related validation performed. RESULTS: As results, this tool shows that agreement between raters is relatively high and the confirmatory factor analysis for constructive validation shows that the tool is valid. Also, for criterion related validation, estimated IQ, insight and MMSE are significantly correlated to understanding, appreciation and reasoning. However competence to express a choice did not show any significant correlation with criterion variables, nor showed BPRS any significant correlation with sub-competences. CONCLUSION: Our study developed the Korean Tool of Competency to Consent to Psychiatric Admission Treatment in the Mentally Ill, verified the reliability and validity of the tool and analyzed the optimum cutoff to distinguish between competence and incompetence in sub-competences. Korean Assessment Tool of Competency to Consent to Psychiatric Hospitalization (KATOC), analyzed the reliability and validity of this tool and presented the cutoff points by subarea. As a result, the reliability and validity of satisfactory levels were verified, the ROC analysis was implemented based on the clinical assessment and the cutoff points were found in understanding, appreciation, expression of a choice and reasoning. Such findings showed that the tool developed by researchers could be very favorably used in Korea.

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  • At least 48% of psychiatric patients have the capacity to decide on hospitalization at the time of admission.

    “Tentatively, it could be said that at least 48% of psychiatric patients do have the capacity to decide on hospitalization at the time of admission (Di & Cheng, 2013;Fraguas et al., 2007;Seo et al., 2011)”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Seo et al., 2011

    The Results (Efficiency of tool; page unavailable) report that 25 of 52 assessed patients—about 48%—were judged able to decide on hospitalization. But the Methods (Participants) describe 98 inpatients overall, and the Discussion says they had been hospitalized for an average of 17.67 months. The paper therefore does not establish that at least 48% of psychiatric patients have this capacity at admission. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Across inpatients, poor insight was a consistent and strong predictor of incapacity.

    “Across inpatients, poor insight was also a consistent and strong predictor of incapacity (G.Owen et al., 2009;G. S. Owen et al., 2011;Seo et al., 2011;Skipworth et al., 2013;Spencer et al., 2018)”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Seo et al., 2011

    The Results (Reliability and validity; page unavailable) link insight with the overall hospitalization-consent score, and the Discussion reports moderate or stronger correlations with appreciation and reasoning. The paper also cites an earlier finding that insight was the strongest predictor of competence versus incompetence. It does not establish that poor insight consistently and strongly predicted incapacity across all competence domains in its own inpatient sample; expression of a choice showed no significant correlation with the criterion variables. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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  1. [25]Kline RB Principles and practice of structural equation modeling: A very readable introduction to the subject, with good coverage of assumptions and SEM's relation to underlying regression, factor, and other techniques 1998 NY Guilford Press

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Authors
Seo, M. K., Kim, S. H., & Rhee, M.
Affiliations
  • Gyeongsang National University (KR)
  • Korea University (KR)
Corresponding author
Rhee, MinKyu
ORCID
Venue
Psychiatry Investigation
Publisher
Korean Neuropsychiatric Association
Published
2011
Volume
8
Issue
1
Pages
39
ISSN
1738-3684 (ISSN-L)
DOI
10.4306/pi.2011.8.1.39
PMC
PMC3079184
OpenAlex
W2111833140
Cited by
6
References
29
Citations by year
2024: 1 · 2021: 1 · 2016: 1 · 2014: 1 · 2013: 1 · 2012: 1
FWCI
1.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychiatry Investigation (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Ministry of Education and Human Resources Development
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 › Health Professions › General Health Professions › Health, Medicine and Society
Keywords
capacity to consent, psychiatric hospitalization, informed consent, mental illness, criterion validity, inter-rater reliability, cut-off values, insight

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