title: Including frequent emergency department users with severe alcohol use disorders in research: assessing capacity.
abstract: OBJECTIVE
  Frequent emergency department (ED) users with severe alcohol use disorders are often excluded from research, in part because assessing capacity to provide consent is challenging. We aim to assess the feasibility of using the University of California, San Diego Brief Assessment of Capacity to Consent, a 5-minute, easy-to-use, validated instrument, to screen for capacity to consent for research in frequent ED users with severe alcohol use disorders.
  
  
  METHODS
  We prospectively enrolled a convenience sample of 20 adults to assess their capacity to provide consent for participation in 30-minute mixed-methods interviews using the 10-question University of California, San Diego Brief Assessment of Capacity to Consent. Participants were identified through an administrative database, had greater than 4 annual ED visits for 2 years, and had severe alcohol use disorders. The study was conducted with institutional review board approval from March to July 2013 in an urban, public, university ED receiving approximately 120,000 visits per year. Blood alcohol concentration and demographic data were extracted from the medical record.
  
  
  RESULTS
  We completed assessments for 19 of 20 participants. One was removed because of agitation. Sixteen of 19 participants passed each question and were deemed capable of providing informed consent. Interventions to improve understanding (prompting and material review) were required for 15 of 19 participants. The mean duration to describe the study and perform the assessment was 10.4 minutes (SD 3 minutes). The mean blood alcohol concentration was 211.5 mg/dL (SD 137.4 mg/dL). The 3 patients unable to demonstrate capacity had blood alcohol concentrations of 226 and 348 mg/dL, with 1 not obtained.
  
  
  CONCLUSIONS
  This pilot study supports the feasibility of using the University of California, San Diego Brief Assessment of Capacity to Consent to assess capacity of frequent ED users with severe alcohol use disorders to participate in research. Blood alcohol concentration was not correlated with capacity.
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY. Electronic address: ryan.mccormack@nyumc.org.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: McCormack
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Timothy
authors.initials: T
authors.lastname: Gallagher
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
authors.affiliation: Department of Population Health, Division of Medical Ethics, New York University School of Medicine, New York, NY.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007258:Informed Consent; D007407:Interviews as Topic; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires