■在法律和医疗保健环境中给予知情同意的能力评估通常仅通过临床判断进行。鉴于公认的基于临床医生的评估在精神卫生部门的可靠性有限,特别是对同意能力的评估,我们的目标是在评估精神分裂症患者做出健康选择的能力时,确定临床判断的可靠性。
因此测试了临床评估与新标准化评估(“对治疗的知情同意评估”-“EICT”量表)评分之间的潜在趋同。该量表评估了能力的四个维度,特别是患者通常如何理解与护理相关的信息(理解);他们如何根据风险/收益比(评估)评估治疗的选择;他们如何在决策过程中连贯地推理(推理);和,最后,他们在治疗方案之间做出选择的能力(表达选择)。由五名具有不同背景的转诊临床医生(精神科医生,法医精神病医生,老年病学家,麻醉师,和医学法律医生)。通过临床医生在全球功能评估量表(GAF)的修订版上获得的分数之间的相关性分析,测试了评估者之间的变异性,该量表专门设计用于主观评估四个能力维度中每个维度的功能。两个经过验证的能力量表(Mac-CAT-T,SICIATRI-R),还使用了神经心理学电池以及评估神经精神症状严重程度和药物副作用的量表。
■个别专家的临床判断显示出很大的评分者之间的差异。同样,在EICT分量表和各自的临床医生评估的GAF量表之间仅发现弱/非显着相关性.相反,在EICT和MacCAT-T分量表之间发现了坚实的相关性。不出所料,健康对照组在知情同意治疗方面表现更好,由三个尺度(即,EICT,MacCAT-T,和SICIATRI-R),和神经心理学测试表现。在患者之间的比较中,根据管理的EICT,能够或不能对治疗给予知情同意,语音口语流利度任务出现显著差异(p=0.038),言语判断(p=0.048),MacCAT-T分量表,和SICIATRI-R总分。此外,EICT表现出优异的内部一致性(Cronbach的α从0.96到0.98的四个分量表),而项目分析,通过测量EICT的每个项目与总分之间的相关性,对所有分量表的所有项目都非常好(阿尔法范围从0.86到0.98)。
■总而言之,我们的研究结果强调,仅通过临床判断来评估能力并不完全可靠,需要标准化工具的支持.因此,EICT量表可用于评估医疗保健和法律背景下的一般同意能力,可能有必要评估精神疾病患者的有效能力。最后,该量表可作为决定患者是否以及在何种程度上需要支持的重要工具.
UNASSIGNED: The competence assessment to give informed consent in the legal and healthcare settings is often performed merely through clinical judgment. Given the acknowledged limited reliability of clinician-based evaluation in the mental health sector, particularly for the assessment of competence to consent, our objective was to ascertain the dependability of clinical judgment when evaluating the ability of schizophrenia patients to make choices about their health.
UNASSIGNED: The potential convergence between clinical evaluation and scores from a new standardized assessment (the \"Evaluation of Informed Consent to Treatment\" - \"EICT\" scale) was therefore tested. The scale assesses four dimensions of competence, specifically how patients normally understand information relating to care (Understanding); how they evaluate the choice of treatment in terms of risk/benefit ratio (Evaluating); how they reason coherently in the decision-making process (Reasoning); and, finally, their ability to make a choice between treatment alternatives (Expressing a choice). Thirty-four outpatients with schizophrenia were evaluated for their competence to consent by five referring clinicians with different backgrounds (psychiatrist, forensic psychiatrist, geriatrician, anesthetist, and medico-legal doctor). Inter-raters variability was tested through correlation analyses between the scores obtained by the clinicians on a modified version of the Global Assessment of Functioning scale (GAF) designed specifically to subjectively assess functioning in each of the four competence dimensions. Two validated competence scales (Mac-CAT-T, SICIATRI-R), and a neuropsychological battery were also administered along with scales for evaluating neuropsychiatric symptoms severity and side effects of medication.
UNASSIGNED: Clinical judgments of the individual specialists showed great inter-rater variability. Likewise, only weak/non-significant correlations were found between the EICT subscales and the respective clinicians-rated GAF scales. Conversely, solid correlations were found between the EICT and MacCAT-T subscales. As expected, healthy controls performed better in the ability to give informed consent to treatment, as measured by the three scales (i.e., EICT, MacCAT-T, and SICIATRI-R), and neuropsychological test performance. In the comparisons between patients who, according to the administered EICT, were able or not able to give informed consent to treatment, significant differences emerged for the Phonemic verbal fluency task (p = 0.038), Verbal judgments (p = 0.048), MacCAT-T subscales, and SICIATRI-R total score. Moreover, EICT exhibited excellent internal consistency (Cronbach\'s alphas ranging from 0.96 to 0.98 for the four subscales) while the Item Analysis, by measuring the correlation between each item of the EICT and the total score, was excellent for all items of all subscales (alphas ranging from 0.86 to 0.98).
UNASSIGNED: In conclusion, our findings highlighted that the assessment of competence exclusively through clinical judgment is not fully reliable and needs the support of standardized tools. The EICT scale could therefore be useful in assessing general competence to consent both in healthcare and legal contexts, where it might be necessary to evaluate the effective competence of patients with psychiatric disorders. Finally, this scale could serve as a valuable tool for decisions regarding whether and to what extent a patient needs support.