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Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool
  1. Rahime Aydin Er1,
  2. Mine Sehiralti2
  1. 1Vocational School of Health, Kocaeli University, Kocaeli, Turkey
  2. 2Department of History of Medicine and Ethics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
  1. Correspondence to Rahime Aydin Er, Vocational School of Health, Kocaeli University, Kocaeli 41380, Turkey; raay{at}kocaeli.edu.tr

Abstract

Objective To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.

Methods This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T.

Results Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients’ relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients’ relatives were statistically significant.

Conclusions Our findings demonstrate those physicians, nurses and the patients’ relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations.

  • Clinical Ethics
  • Psychiatry
  • Informed Consent
  • Competence/incompetence
  • Capacity

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