title: Assessing medical decision making capacity among cancer patients: Preliminary clinical experience of using a competency assessment instrument.
abstract: OBJECTIVE
  This study investigates the usefulness of the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory (SICIATRI) for cancer patients, which is a structured interview that assesses a patient's competency in clinical practice.
  
  
  METHODS
  The SICIATRI, originally developed to measure patients' competency to give informed consent, were administered referred cancer patients who needed for assessing medical decision making capacity. The usefulness of the SICIATRI was investigated retrospectively. Recommendation for modification of the SICIATRI for cancer patients if applicable were made by the research team.
  
  
  RESULTS
  Among the 433 cancer patients referred for psychiatric consultation, 12 were administered the SICIATRI and all of the administration were conducted without big problems. All patients were 60 years or older. The most common purpose for competency evaluation was to analyze patients' understanding of the anti-cancer treatment proposed by oncologists, followed by their refusal of the treatment. Half of the patients (n = 6) were diagnosed with delirium and three among them were judged as having the most impaired status of a patient's competency. Two patients (17%) were diagnosed with major depression and another two (17%) were mental retardation and each one patient was diagnosed with dementia and past history of alcohol dependence. Among 6 patients without delirium 5 subjects including a dementia patient were judged as fully competent. Total of 5 small potential modifications of the SICIATRI for its use with Japanese cancer patients were recommended.
  
  
  CONCLUSIONS
  Our experience suggests that the SICIATRI is a useful instrument for psycho-oncology clinical practice.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Toru
authors.initials: T
authors.lastname: Okuyama
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Megumi
authors.initials: M
authors.lastname: Uchida
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Koji
authors.initials: K
authors.lastname: Sugano
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Division of Palliative Care and Psycho-oncology,Nagoya City University Hospital.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Division of Palliative Medicine, Department of Internal Related Kobe University Graduate School of Medicine.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000150:complications / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology* / Q000592:standards; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods
keywords: Cancer; Decision making; Informed consent; Psychiatric co-morbidity