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Decisional capacity

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https://www.readbyqxmd.com/read/28701031/patient-s-cognitive-function-and-attitudes-towards-family-involvement-in-cancer-treatment-decision-making-a-patient-family-caregiver-dyadic-analysis
#1
Dong Wook Shin, Juhee Cho, Debra L Roter, So Young Kim, Jong Hyock Park, Hyung Kook Yang, Hyun Woo Lee, Sun-Seog Kweon, Yune Sik Kang, Keeho Park
Purpose: Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. Materials and Methods: A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea, and were asked to express their preferences for family involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment)...
July 4, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28559033/refusal-of-emergency-medical-treatment-case-studies-and-ethical-foundations
#2
Catherine A Marco, Jay M Brenner, Chadd K Kraus, Norine A McGrath, Arthur R Derse
Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans...
May 27, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28553898/influence-of-psychiatric-symptoms-on-decisional-capacity-in-treatment-refusal
#3
Joshua M Baruth, Maria I Lapid
How psychiatric symptoms affect patients' decision making in practice can inform how we think-theoretically and conceptually-about what it means for those patients to have decision-making capacity. Assessment of a patient's decisional capacity allows those with adequate capacity to make choices regarding treatment and protects those who lack capacity from potential harm caused by impaired decision making. In analyzing a case in which a patient with stage II breast cancer refuses further treatment, we review the conceptual model of informed consent and approaches to assessing decision-making capacity that are in accordance with the American Medical Association Code of Medical Ethics as well as tools to assess decisional capacity...
May 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28544648/effects-of-a-web-based-patient-decision-aid-on-biologic-and-small-molecule-agents-for-rheumatoid-arthritis-answer-2-a-proof-of-concept-study
#4
Linda C Li, Chris Shaw, Diane Lacaille, Elaine Yacyshyn, C Allyson Jones, Cheryl Koehn, Alison M Hoens, Jasmina Geldman, Eric C Sayre, Graham Macdonald, Jenny Leese, Nick Bansback
OBJECTIVES: To assess the extent to which ANSWER-2, an interactive online patient decision aid, reduces patients' decisional conflict and improves their medication-related knowledge and self-management capacity. METHODS: We used a pre-post study design. Eligible participants had a diagnosis of rheumatoid arthritis (RA), had been recommended to start using a biologic or small molecule agent or to switch to a new one, and had Internet access. Access to ANSWER-2 was provided immediately after enrollment...
May 23, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28507770/the-recovery-of-factors-associated-with-decision-making-capacity-in-individuals-with-psychosis
#5
Colin Fernandez, Harry G Kennedy, Miriam Kennedy
BACKGROUND: There is limited data on the recovery of factors associated with decisional capacity in patients with psychosis. AIMS: To study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis. METHOD: Fifty-six patients with psychosis were assessed for capacity to consent to treatment on admission and at 6 and 12 weeks following treatment. The MacArthur Competence Assessment Tool - Treatment, the Positive and Negative Symptom Scale and the Global Assessment of Functioning Scale were used to measure mental capacities, symptom severity and global functioning respectively...
May 2017: BJPsych Open
https://www.readbyqxmd.com/read/28407800/advance-directives-and-power-of-attorney-for-health-care-in-the-oldest-old-results-of-the-agequalide-study
#6
Tobias Luck, Francisca S Rodriguez, Birgitt Wiese, Carolin van der Leeden, Kathrin Heser, Horst Bickel, Jürgen In der Schmitten, Hans-Helmut Koenig, Siegfried Weyerer, Silke Mamone, Tina Mallon, Michael Wagner, Dagmar Weeg, Angela Fuchs, Christian Brettschneider, Jochen Werle, Martin Scherer, Wolfgang Maier, Steffi G Riedel-Heller
BACKGROUND: Completion of advance directives (ADs) and power of attorney (POA) documents may protect a person's autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA. METHODS: We analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study...
April 13, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28379834/ethical-considerations-in-electronic-monitoring-of-the-cognitively-impaired
#7
Y Tony Yang, Charles G Kels
Cognitive impairment afflicts an estimated 16 million people in the United States. Wandering is a concerning behavior associated with cognitive impairment, as it may threaten patient safety. The risks posed by wandering place severe burdens on both professional and informal caregivers, as well as law enforcement institutions throughout the United States. As such, location trackers that could reduce this burden have become increasingly prevalent. As with many assistive technologies, the substantial promise of location trackers is counterbalanced by potential pitfalls with respect to loss of privacy and autonomy...
March 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28366903/guardianship-and-clinical-research-participation-the-case-of-wards-with-disorders-of-consciousness
#8
Megan S Wright, Michael R Ulrich, Joseph J Fins
We review relevant federal law about research on human subjects and state laws on guardian authority to determine whether guardians can consent on behalf of their wards to participation in research. The Common Rule is silent on the issue as are most state guardianship laws. Our analysis shows significant variation in guardians' decision-making authority in the states that do regulate wards' participation in research.We consider how the appointment of guardians for patients with disorders of consciousness (DOC) impacts such patients' access to research...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28366202/human-predatory-behavior-and-the-social-implications-of-communal-hunting-based-on-evidence-from-the-td10-2-bison-bone-bed-at-gran-dolina-atapuerca-spain
#9
Antonio Rodríguez-Hidalgo, Palmira Saladié, Andreu Ollé, Juan Luis Arsuaga, José María Bermúdez de Castro, Eudald Carbonell
Zooarcheological research is an important tool in reconstructing subsistence, as well as for inferring relevant aspects regarding social behavior in the past. The organization of hunting parties, forms of predation (number and rate of animals slaughtered), and the technology used (tactics and tools) must be taken into account in the identification and classification of hunting methods in prehistory. The archeological recognition of communal hunting reflects an interest in evolutionary terms and their inherent implications for anticipatory capacities, social complexity, and the development of cognitive tools, such as articulated language...
April 2017: Journal of Human Evolution
https://www.readbyqxmd.com/read/28336349/decisional-capacity-for-advanced-care-directives-in-parkinson-s-disease-with-cognitive-concerns
#10
Muneer Abu Snineh, Richard Camicioli, Janis M Miyasaki
INTRODUCTION: Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia...
March 8, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28248746/a-context-oriented-communication-algorithm-for-advance-care-planning-a-model-to-assist-palliative-care-in-heart-failure
#11
JinShil Kim, Shinmi Kim, Mi-Seung Shin, Jae Ok Jin, Yunmi Kim, Mee-Ok Lee
BACKGROUND: Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF). OBJECTIVES: The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions. METHODS: Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model...
February 28, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28154452/determinants-of-capacity-to-consent-to-research-on-alzheimer-s-disease
#12
Barton W Palmer, Alexandrea L Harmell, Luz L Pinto, Laura B Dunn, Scott Y H Kim, Shahrokh Golshan, Dilip V Jeste
OBJECTIVE: Investigators conducting Alzheimer's disease (AD) research need to consider participants' capacity to consent. Cognitive functioning is a significant predictor of decisional capacity, but there is a dearth of information on the influence of neuropsychiatric symptoms in AD on decisional capacity. We examined the rates of decisional capacity associated with two types of research protocols, and the association of capacity with neuropsychiatric symptoms and other participant characteristics...
2017: Clinical Gerontologist
https://www.readbyqxmd.com/read/27876273/the-macarthur-competence-assessment-tools-for-assessing-decision-making-capacity-in-schizophrenia-a-meta-analysis
#13
Shi-Bin Wang, Yuan-Yuan Wang, Gabor S Ungvari, Chee H Ng, Ren-Rong Wu, Jijun Wang, Yu-Tao Xiang
OBJECTIVE: This meta-analysis aimed to examine the decisional capacity measured by the MacArthur Competence Assessment Tools (MacCAT) in schizophrenia. METHOD: English (PubMed, PsycINFO, Embase, Cochrane Library databases and the Cochrane Controlled Trials Register) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from 1995 until August 1, 2016. Weighted and standardized mean differences were calculated...
November 18, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/27874181/ags-position-statement-making-medical-treatment-decisions-for-unbefriended-older-adults
#14
Timothy W Farrell, Eric Widera, Lisa Rosenberg, Craig D Rubin, Aanand D Naik, Ursula Braun, Alexia Torke, Ina Li, Caroline Vitale, Joseph Shega
In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision-making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf...
November 22, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27872409/complexity-analysis-of-decision-making-in-the-critically-ill
#15
Barbara J Daly, Sara L Douglas, Elizabeth O'Toole, James Rowbottom, Alan Hoffer, Amy R Lipson, Christopher Burant
RATIONALE: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. OBJECTIVE: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27806700/autonomy-of-the-child-in-the-south-african-context-is-a-12%C3%A2-year-old-of-sufficient-maturity-to-consent-to-medical-treatment
#16
Wandile Ganya, Sharon Kling, Keymanthri Moodley
BACKGROUND: A child is a developing person with evolving capacities that include autonomy, mental (decisional) capacity and capacity to assume responsibility. Hence, children are entitled to participatory (autonomy) rights in South Africa as observed in the Children's Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand the various implications of the treatment including the risks and benefits thereof...
November 2, 2016: BMC Medical Ethics
https://www.readbyqxmd.com/read/27669132/the-limits-of-informed-consent-for-an-overwhelmed-patient-clinicians-role-in-protecting-patients-and-preventing-overwhelm
#17
Johan Bester, Cristie M Cole, Eric Kodish
In this paper, we examine the limits of informed consent with particular focus on ways in which various factors can overwhelm decision-making capacity. We introduce overwhelm as a phenomenon commonly experienced by patients in clinical settings and distinguish between emotional overwhelm and informational overload. We argue that in these situations, a clinician's primary duty is prevention of harm and suggest ways in which clinicians can discharge this obligation. To illustrate our argument, we consider the clinical application of genetic sequencing testing, which involves scientific and technical information that can compromise the understanding and decisional capacity of most patients...
September 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27591409/enhancing-the-informed-consent-process-in-psychiatric-outpatients-with-a-brief-computer-based-method
#18
Inés Morán-Sánchez, Aurelio Luna, Maria D Pérez-Cárceles
Informed consent is a key element of ethical clinical research. Those with mental disorders may be at risk for impaired consent capacity. Problems with procedures may also contribute to patient's ´difficulties in understanding consent forms. The present investigation explores if a brief technologically based information presentation of the informed consent process may enhance psychiatric patients understanding and satisfaction. In this longitudinal, within-participants comparison study, patients who initially were judged to lack capacity to make research decisions (n=41) and a control group (n=47) were followed up...
November 30, 2016: Psychiatry Research
https://www.readbyqxmd.com/read/27556657/nurses-perception-of-shared-decision-making-processes-quantifying-a-shared-governance-culture
#19
Sally O Gerard, Deborah L Owens, Patricia Oliver
OBJECTIVE: The aim of this study is to describe how measuring the perceived and desired decision-making capacity of nurses in a model of shared governance (SG) can be beneficial. BACKGROUND: Shared governance (SG) increases nurse's control over professional practice. Engagement in SG can be impacted by how much decision-making power nurses desire. This concept related to decision making has been termed decisional involvement (DI). Few studies exist that examine the concept of DI...
September 2016: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27551024/assessment-of-healthcare-decision-making-capacity
#20
REVIEW
Barton W Palmer, Alexandrea L Harmell
It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making...
September 2016: Archives of Clinical Neuropsychology: the Official Journal of the National Academy of Neuropsychologists
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