Variable judgments of decisional capacity in cognitively impaired research subjects.
Variable judgments of decisional capacity in cognitively impaired research subjects.
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DOI：
10.1111/j.1532-5415.2008.01922.x
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发表时间：
2008-10
影响因子：
6.3
通讯作者：
Sachs GA
中科院分区：
文献类型：
--
作者：
Stocking CB;Hougham GW;Danner DD;Patterson MB;Whitehouse PJ;Sachs GA
比较研究助理（RA）和家庭照顾者/代理人对认知障碍患者决策能力的评估;并确定是否有一组或两组根据具体（假设）研究入组决定对能力进行不同的判断。三个诊所，分别位于俄亥俄州、肯塔基州和伊利诺斯州，149名确诊为痴呆症的患者及其护理者/代理人作为较长访谈的一部分，患者被问及未来是否参加五个假设的研究项目，这些项目的风险和益处各不相同。在患者报告了每个决定及其原因后，RA（使用Applebaum & Grisso的四个标准）表明患者是否有能力自己做出决定。在单独的访谈中，要求照顾者/代理人根据与患者的生活经验进行类似的评估。RA和代理判断进行了比较。能力判断RA和照顾者不同的具体项目，大多数患者。RA和代理人判断之间的协议因项目而异，但协议仅在Kappa测试时是“公平的”（数据范围为.21 - .39）。有50名患者被代理人评估为有能力做出所有决定，47名患者被RA评估为有能力做出所有决定。其中只有24人是同一个病人。如果重新评估每个入组决策的能力，更多的潜在参与者可以在做出这些决策时保持权威。
To compare assessments of the decisional capacity of cognitively impaired patients by research assistants (RAs) and by family caregiver/proxies; and to determine whether either or both groups judge capacity differently depending on the specific (hypothetical) research enrollment decision being made. Cross sectional Three clinics, one each in Ohio, Kentucky and Illinois 149 patients with established dementia diagnoses and their caregiver/proxies As part of a longer interview, patients were asked about future enrollment in five hypothetical research projects with varying risks and benefits. After patients reported each decision and reasons for that decision, RAs (using Applebaum & Grisso’s four standards) indicated whether the patient was competent to make that decision on their own. In separate interviews, caregiver/proxies were asked for a similar appraisal based on life experience with the patient. RA and proxy judgments were compared. Capacity judgments by RAs and by caregivers differed by specific project for most patients. Agreement between RA and proxy judgments varied by project but agreement was only “fair’ when tested by kappa (range in data .21 - .39). There were 50 patients who were appraised as competent for all decisions by proxies and 47 who were so assessed by RAs. Of these only 24 were the same patients. If capacity were assessed anew for each enrollment decision, more potential participants could maintain authority in making those decisions.
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影响因子：
9.9
作者：
Stocking, CB;Hougham, GW;Sachs, GA
通讯作者：
Sachs, GA
DOI：
10.1111/j.1532-5415.2007.01318.x
发表时间：
2007-10-01
影响因子：
6.3
作者：
Stocking, Carol B.;Hougham, Gavin W.;Sachs, Greg A.
通讯作者：
Sachs, Greg A.
影响因子：
7.2
作者：
Kim, SYH;Karlawish, JHT;Caine, ED
通讯作者：
Caine, ED
影响因子：
--
作者：
MARSON, DC;INGRAM, KK;HARRELL, LE
通讯作者：
HARRELL, LE
影响因子：
120.7
作者：
DRANE, JF
通讯作者：
DRANE, JF