THE RATIONAL CLINICIAN’S CORNER CLINICAL EXAMINATION Does This Patient Have Medical Decision-Making Capacity? Laura L. Sessums, JD, MD Context Evaluation of the capacity of a patient to make medical decisions should occur in the context of specific medical decisions when incapacity is considered. Hanna Zembrzuska, MD Jeffrey L. Jackson, MD, MPH Objective To determine the prevalence of incapacity and assessment accuracy in adult medicine patients without severe mental illnesses. CLINICAL SCENARIO Data Sources MEDLINE and EMBASE (from their inception through April 2011) and bibliographies of retrieved articles. One of your patients, a 72-year-old woman, comes to you for a preopera- Study Selection We included high-quality prospective studies (n = 43) of instru- ments that evaluated medical decision-making capacity for treatment decisions. tive evaluation for a total hip replace- ment. Her medical history includes Data Extraction Two authors independently appraised study quality, extracted rel- early-stage Alzheimer disease. At a re- evant data, and resolved disagreements by consensus. cent clinic visit, her husband noted his Data Synthesis Incapacity was uncommon in healthy elderly control participants wife seemed more forgetful, and on ex- (2.8%; 95% confidence interval [CI], 1.7%-3.9%) compared with medicine inpa- amination, her Mini-Mental State Ex- tients (26%; 95% CI,
JAMA – American Medical Association
Published: Jul 27, 2011
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