Abstract：
UNASSIGNED: In Italy, the law n. 219/2017 regarding informed consent states that \"Communication time between doctor and patient constitutes treatment time\". Legal guardian is designated as a proxy to consent on the child\'s behalf. The issue of proxy informed consent should be approached with a model for parent-child decision-making that is participatory, collaborative, respects and supports the autonomy of child by recognizing their evolving capacities. We aim to assess the informed consent related to healthcare decisions for medically fragile child, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T).
UNASSIGNED: An observational study has been conducted at a Child Neuropsychiatry Service, administering a semi-structured interview with customized questionnaire to examine their capacities in four areas of the MacCAT-T. Results were evaluated with the Pearson correlation coefficient for the cognitive and adaptive levels of the Wechsler-Intelligence-Scale-for-Children (WISC-IV) and the Vineland-Adaptive-Behavior-Scales-II (VABS-II).
UNASSIGNED: The MacCAT-T domains Understanding, Appreciation, Reasoning, Expressing a Choice were correlated with the cognitive and adaptive levels of the WISC-IV and the VABS-II. Understanding, Appreciation and Expressing a choice have positive correlation with the Communication and Socialization scores of VABS-II; Reasoning has positive correlation with the Working-Memory-Index scores of the WISC-IV. The study enabled to assess the informed consent processes in vulnerable children and although demonstrating how they participate in their care process in a mostly unconscious way, making the frail children more involved in their own care process was possible. Future studies should assess the impact of incorporating MacCAT-T into standard informed consent in other settings.
UNASSIGNED: An observational study has been conducted at a Child Neuropsychiatry Service, administering a semi-structured interview with customized questionnaire to examine their capacities in four areas of the MacCAT-T. Results were evaluated with the Pearson correlation coefficient for the cognitive and adaptive levels of the Wechsler-Intelligence-Scale-for-Children (WISC-IV) and the Vineland-Adaptive-Behavior-Scales-II (VABS-II).
UNASSIGNED: The MacCAT-T domains Understanding, Appreciation, Reasoning, Expressing a Choice were correlated with the cognitive and adaptive levels of the WISC-IV and the VABS-II. Understanding, Appreciation and Expressing a choice have positive correlation with the Communication and Socialization scores of VABS-II; Reasoning has positive correlation with the Working-Memory-Index scores of the WISC-IV. The study enabled to assess the informed consent processes in vulnerable children and although demonstrating how they participate in their care process in a mostly unconscious way, making the frail children more involved in their own care process was possible. Future studies should assess the impact of incorporating MacCAT-T into standard informed consent in other settings.
摘要：
■在意大利，关于知情同意的第219/2017号法律规定，“医生和患者之间的沟通时间构成治疗时间”。法定监护人被指定为代表儿童同意的代理人。代理知情同意的问题应该用参与性的亲子决策模型来处理，协作,通过承认儿童不断发展的能力，尊重和支持儿童的自主权。我们旨在评估与医疗脆弱儿童的医疗保健决定相关的知情同意，使用麦克阿瑟能力评估工具进行治疗（MacCAT-T）。
■一项观察性研究在儿童神经精神病学中心进行，使用定制问卷进行半结构化访谈，以检查他们在MacCAT-T的四个领域的能力。用皮尔逊相关系数评估韦氏儿童智力量表（WISC-IV）和Vineland自适应行为量表-II（VABS-II）的认知和适应水平。
■MacCAT-T领域理解，感谢,推理,表达选择与WISC-IV和VABS-II的认知和适应水平相关。理解,欣赏和表达选择与VABS-II的沟通和社交得分呈正相关；推理与WISC-IV的工作记忆指数得分呈正相关。该研究能够评估弱势儿童的知情同意过程，尽管展示了他们是如何以大多数无意识的方式参与他们的护理过程的，让虚弱的孩子更多地参与他们自己的护理过程是可能的。未来的研究应评估将MacCAT-T纳入其他背景下的标准知情同意书的影响。
■一项观察性研究在儿童神经精神病学中心进行，使用定制问卷进行半结构化访谈，以检查他们在MacCAT-T的四个领域的能力。用皮尔逊相关系数评估韦氏儿童智力量表（WISC-IV）和Vineland自适应行为量表-II（VABS-II）的认知和适应水平。
■MacCAT-T领域理解，感谢,推理,表达选择与WISC-IV和VABS-II的认知和适应水平相关。理解,欣赏和表达选择与VABS-II的沟通和社交得分呈正相关；推理与WISC-IV的工作记忆指数得分呈正相关。该研究能够评估弱势儿童的知情同意过程，尽管展示了他们是如何以大多数无意识的方式参与他们的护理过程的，让虚弱的孩子更多地参与他们自己的护理过程是可能的。未来的研究应评估将MacCAT-T纳入其他背景下的标准知情同意书的影响。
