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Decisional capacity

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https://www.readbyqxmd.com/read/29581818/a-case-for-the-standardized-assessment-of-testamentary-capacity
#1
REVIEW
Megan Brenkel, Kimberley Whaley, Nathan Herrmann, Kerri Crawford, Elias Hazan, Laura Cardiff, Adrian M Owen, Kenneth Shulman
Background: With an increasingly aged, frail population that holds a disproportionate amount of wealth, clinicians (especially those with expertise in older adults) may be asked with more frequency to offer a clinical opinion on testamentary capacity (TC), the mental capacity to make a will. Method: This paper reviews the legal criteria as well as the empirical research on assessment tools for determining testamentary capacity (TC). We also review the relevance of instruments used for the assessment of other decisional capacities in order to evince the potential value of developing a standardized assessment of TC for clinician experts...
March 2018: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/29523757/making-medical-decisions-for-an-incompetent-older-adult-when-both-a-proxy-and-an-advance-directive-are-available-which-is-more-likely-to-reflect-the-older-adult-s-preferences
#2
Gina Bravo, Modou Sene, Marcel Arcand
OBJECTIVES: To investigate which of two sources of information about an older adult's wishes-choices made in an advance directive or proxy's opinion-provides better insight into the older adult's preferences measured in hypothetical clinical situations involving decisional incapacity. METHODS: Secondary analyses of data collected from 157 community-dwelling, decisionally competent adults aged 70 years and over who attended a group information session on advance directives with their proxy...
March 9, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29506512/euthanasia-and-assisted-suicide-for-people-with-an-intellectual-disability-and-or-autism-spectrum-disorder-an-examination-of-nine-relevant-euthanasia-cases-in-the-netherlands-2012-2016
#3
Irene Tuffrey-Wijne, Leopold Curfs, Ilora Finlay, Sheila Hollins
BACKGROUND: Euthanasia and assisted suicide (EAS) have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: (a) voluntary and well-considered request; (b) unbearable suffering without prospect of improvement; (c) informing the patient; (d) lack of a reasonable alternative; (e) independent second physician's opinion. 'Unbearable suffering' must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy...
March 5, 2018: BMC Medical Ethics
https://www.readbyqxmd.com/read/29498429/understanding-mothers-decision-making-needs-for-autopsy-consent-after-stillbirth-framework-analysis-of-a-large-survey
#4
Anne Schirmann, Frances M Boyle, Dell Horey, Dimitrios Siassakos, David Ellwood, Ingrid Rowlands, Vicki Flenady
BACKGROUND: Experiencing stillbirth is devastating and leaves parents searching for causes. Autopsy is the gold standard for investigation, but deciding to consent to this procedure is very difficult for parents. Decision support in the form of clear, consistent, and parent-centered information is likely to be helpful. The aims of this study were to understand the influences on parents' decisions about autopsy after stillbirth and to identify attributes of effective decision support that align with parents' needs...
March 2, 2018: Birth
https://www.readbyqxmd.com/read/29406794/evidence-based-medicine-in-otolaryngology-part-7-introduction-to-shared-decision-making
#5
Allison K Ikeda, Paul Hong, Stacey L Ishman, Stephanie A Joe, Gregory W Randolph, Jennifer J Shin
Shared decision making (SDM) is a collaborative process in which patients, families, and clinicians develop a mutually agreed upon treatment plan when more than one reasonable treatment option exists. This cooperative engagement fosters improvements in patient satisfaction, disease management, and outcomes and also has the capacity to promote evidence-based care. Thus, this seventh installment of our Evidence-Based Medicine in Otolaryngology series focuses on SDM. We introduce SDM, including its potential to reduce decisional conflict and decisional regret, when it should be used, its potential benefits, barriers to implementation, and its role in the management of chronic disease and otolaryngological conditions...
April 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29398351/assessing-the-decision-making-capacity-of-terminally-ill-patients-with-cancer
#6
Elissa Kolva, Barry Rosenfeld, Rebecca Saracino
OBJECTIVE: Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients...
December 27, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29325614/ethical-issues-in-neurogenetics
#7
Wendy R Uhlmann, J Scott Roberts
Many neurogenetic conditions are inherited and therefore diagnosis of a patient will have implications for the patient's relatives and can raise ethical issues. Predictive genetic testing offers asymptomatic relatives the opportunity to determine their risk status for a neurogenetic condition, and professional guidelines emphasize patients' autonomy and informed, voluntary decision making. Beneficence and nonmaleficence both need to be considered when making decisions about disclosure and nondisclosure of genetic information and test results...
2018: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29182458/multimedia-aided-consent-for-alzheimer-s-disease-research
#8
Barton W Palmer, Alexandrea L Harmell, Laura B Dunn, Scott Y Kim, Luz L Pinto, Shahrokh Golshan, Dilip V Jeste
OBJECTIVES: Optimizing the research consent process simultaneously fosters respect for autonomy and protection of those with diminished capacity for autonomy. This study evaluated the effectiveness of an enhanced research consent procedure, employing multimedia disclosure and corrective feedback, in improving decisional capacity among 114 people with mild-to-moderate Alzheimer's disease (AD) and 134 non-psychiatric comparison (NC) subjects. METHODS: Participants were randomized to consent type (routine versus enhanced) and protocol type (lower versus higher risk)...
January 2018: Clinical Gerontologist
https://www.readbyqxmd.com/read/29165779/resilience-to-post-traumatic-stress-among-world-trade-center-survivors-a-mixed-methods-study
#9
Lisa M Gargano, Sindhushree Hosakote, Qi Zhi, Kristine A Qureshi, Robyn R Gershon
The purpose of this study was to identify individual characteristics, behaviors, and psychosocial factors associated with symptoms of post-traumatic stress disorder (PTSD) among World Trade Center (WTC) disaster evacuation survivors. The study utilized a mixed-method design. In-depth interviews were conducted using a prepared script. PTSD was assessed using the PTSD checklist-civilian (PCL-C; a score ≥ 50 indicates probable PTSD). Thematic analysis was conducted to identify factors associated with PTSD. A purposive sample of 29 WTC evacuees was recruited using a multimodal recruitment strategy...
September 2017: Journal of Emergency Management: JEM
https://www.readbyqxmd.com/read/29141449/decisions-and-attitudes-regarding-participation-and-proxy-in-clinical-trials-among-patients-with-impaired-cognitive-function
#10
S Stormoen, I M Tallberg, O Almkvist, M Eriksdotter, E Sundström
Background Medical decision-making capacity is impaired in Alzheimer's disease and mild cognitive impairment. Medical decision-making capacity depends on many different cognitive functions and varies due to situation and cognitive, social, and emotional status of the patient. Our aim was to analyze dementia patients' capacity to estimate risks and benefits in different clinical trials and determine how cognitive decline affects their attitude toward possible participation and proxy consent. Methods Groups: Alzheimer's disease (n = 20), mild cognitive impairment (n = 21) and healthy controls (n = 33)...
January 1, 2017: Dementia
https://www.readbyqxmd.com/read/29132946/an-interview-study-of-patient-and-caregiver-perspectives-on-advance-care-planning-in-esrd
#11
Marcus Sellars, Josephine M Clayton, Rachael L Morton, Tim Luckett, William Silvester, Lucy Spencer, Carol A Pollock, Rowan G Walker, Peter G Kerr, Allison Tong
BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, it can be an emotionally charged process for patients with kidney disease and their caregivers. This study aimed to describe the perspectives and attitudes of patients with end-stage renal disease (ESRD) and their caregivers toward ACP. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Patients with ESRD (n=24) and their caregivers (n=15) aged 36 to 91 years at various stages of ACP ("not commenced," "in progress," or "completed") from 3 renal services...
February 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29096914/the-medical-incapacity-hold-a-policy-on-the-involuntary-medical-hospitalization-of-patients-who-lack-decisional-capacity
#12
Erick H Cheung, Jonathan Heldt, Thomas Strouse, Paul Schneider
BACKGROUND: Medically hospitalized patients who lack decisional capacity may request, demand, or attempt to leave the hospital despite grave risk to themselves. The treating physician in this scenario must determine how to safeguard such patients, including whether to attempt to keep them in the hospital. However, in many jurisdictions, there are no laws that address this matter directly. In this absence, psychiatrists are often called upon to issue an involuntary psychiatric hold (civil commitment) to keep the patient from leaving...
March 2018: Psychosomatics
https://www.readbyqxmd.com/read/28940348/empty-spaces
#13
Adira Hulkower
"I'm Jewish, you know, and my mother said, 'Always trust the rabbis.'" I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility-white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces-the absence of his voice, the too-large bed for his shrinking frame, the always-empty chair by his bedside, and most of all, the myriad gaps in his life story...
September 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28935115/characteristics-of-patients-with-constant-observers
#14
Susan Solimine, Junji Takeshita, Deborah Goebert, June Lee, Brian Schultz, Maria Guerrero, Michael Tanael, Mark Pilar, Loraine Fleming, Stacy Kracher, Leah Lawyer
BACKGROUND: The use of constant observers ("sitters") has been common practice in many medical centers to maintain patient safety. RESULTS: A retrospective chart review of patients who required sitters from October 1, 2007 to September 31, 2013 at a large, private hospital serving a multiethnic community showed that the top reasons for sitters include suicide risk, agitation, fall risk, interfering with medical devices, and confusion/disorientation. Sitters were used for a mean of 3...
January 2018: Psychosomatics
https://www.readbyqxmd.com/read/28918381/assessing-decisional-capacity-for-research-participation-in-psychiatric-patients-and-their-relatives
#15
Donae Elizabeth George, Saumil Dholakia, Prathap Tharyan
A cross-sectional study among adult inpatients with non-organic psychiatric disorders, and among their key relatives, assessed their comprehension and recall of key information in consent forms. It also assessed their capacity to consent to participate in two hypothetical randomised controlled trials (RCTs) with different potential risks and burdens, using structured questionnaires and recorded interviews. Of the 24 participants (12 patient-key relative dyads), seven patients (58%) and three key relatives (25%) were clinically judged to lack the capacity to consent...
August 8, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28916521/behavioral-modeling-and-electrophysiological-evidence-for-supramodality-in-human-metacognition
#16
Nathan Faivre, Elisa Filevich, Guillermo Solovey, Simone Kühn, Olaf Blanke
Human metacognition, or the capacity to introspect on one's own mental states, has been mostly characterized through confidence reports in visual tasks. A pressing question is to what extent results from visual studies generalize to other domains. Answering this question allows determining whether metacognition operates through shared, supramodal mechanisms or through idiosyncratic, modality-specific mechanisms. Here, we report three new lines of evidence for decisional and postdecisional mechanisms arguing for the supramodality of metacognition...
January 10, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28887888/neurocognitive-impairment-addressing-couple-and-family-challenges
#17
John S Rolland
Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development...
December 2017: Family Process
https://www.readbyqxmd.com/read/28882828/systematic-review-and-meta-analysis-of-factors-that-help-or-hinder-treatment-decision-making-capacity-in-psychosis
#18
REVIEW
Amanda Larkin, Paul Hutton
BackgroundThe evidence on factors that may influence treatment decisional capacity ('capacity') in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it.AimsTo determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment-related factors, thus providing a thorough synthesis of current knowledge.MethodWe conducted a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis, assessing the direction, magnitude, significance and reliability of reported associations...
October 2017: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/28840485/how-surrogates-decide-a-secondary-data-analysis-of-decision-making-principles-used-by-the-surrogates-of-hospitalized-older-adults
#19
Rohit Devnani, James E Slaven, Gabriel T Bosslet, Kianna Montz, Lev Inger, Emily S Burke, Alexia M Torke
BACKGROUND: Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions should focus on a patient's preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients. OBJECTIVES: We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so...
December 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28801195/avoidance-of-accelerated-aging-in-schizophrenia-clinical-and-biological-characterization-of-an-exceptionally-high-functioning-individual
#20
Barton W Palmer, Raeanne C Moore, Lisa T Eyler, Luz L Pinto, Elyn R Saks, Dilip V Jeste
OBJECTIVE: To determine the clinical and biological characteristics of an exceptionally high functioning index person (IP) with schizophrenia in her mid-50s, which may represent compensatory mechanisms, and potentially, avoidance of the accelerated aging typically associated with schizophrenia. METHOD: IP, 11 other women with schizophrenia, and 11 non-psychiatric comparison (NC) women were assessed with standard ratings of psychopathology, neurocognitive function, decisional capacity, and functional brain imaging...
August 8, 2017: Schizophrenia Research
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