Assessment of the capacity to consent to treatment in patients admitted to acute medical wards.

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Version: author
Serval ID
serval:BIB_CC705F4195A0
Type
Article: article from journal or magazin.
Collection
Publications
Title
Assessment of the capacity to consent to treatment in patients admitted to acute medical wards.
Journal
BMC medical ethics
Author(s)
Fassassi S., Bianchi Y., Stiefel F., Waeber G.
ISSN
1472-6939[electronic]
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
10
Pages
15
Language
english
Notes
Publication types: Journal Article - Publication Status: epublish
Abstract
BACKGROUND: Assessment of capacity to consent to treatment is an important legal and ethical issue in daily medical practice. In this study we carefully evaluated the capacity to consent to treatment in patients admitted to an acute medical ward using an assessment by members of the medical team, the specific Silberfeld's score, the MMSE and an assessment by a senior psychiatrist. METHODS: Over a 3 month period, 195 consecutive patients of an internal medicine ward in a university hospital were included and their capacity to consent was evaluated within 72 hours of admission. RESULTS: Among the 195 patients, 38 were incapable of consenting to treatment (unconscious patients or severe cognitive impairment) and 14 were considered as incapable of consenting by the psychiatrist (prevalence of incapacity to consent of 26.7%). Agreement between the psychiatrist's evaluation and the Silberfeld questionnaire was poor (sensitivity 35.7%, specificity 91.6%). Experienced clinicians showed a higher agreement (sensitivity 57.1%, specificity 96.5%). A decision shared by residents, chief residents and nurses was the best predictor for agreement with the psychiatric assessment (sensitivity 78.6%, specificity 94.3%). CONCLUSION: Prevalence of incapacity to consent to treatment in patients admitted to an acute internal medicine ward is high. While the standardized Silberfeld questionnaire and the MMSE are not appropriate for the evaluation of the capacity to consent in this setting, an assessment by the multidisciplinary medical team concurs with the evaluation by a senior psychiatrist.
Pubmed
Web of science
Open Access
Yes
Create date
01/10/2009 16:57
Last modification date
20/08/2019 16:47
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