Instruments to assess decision-making capacity: an overview.
OBJECTIVE
The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice.


METHODS
The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability.


RESULTS
The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability.


CONCLUSIONS
Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.
Vellinga
Astrid
A
Center for Ethics and Philosophy of Life, VU University Medical Center, Amsterdam, The Netherlands. astrid.vellinga@mentrum.nl
Smit
Johannes H
JH
van Leeuwen
Evert
E
van Tilburg
Willem
W
Jonker
Cees
C
D000368:Aged; D003657:Decision Making; D030881:Disclosure; D005852:Geriatric Psychiatry / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016743:Mental Competency; D001523:Mental Disorders / Q000523:psychology; D011570:Psychiatry / Q000295:instrumentation / Q000379:methods*; D015203:Reproducibility of Results