Assessing medical decision making capacity among cancer patients : Preliminary clinical experience of using a competency assessment instrument
Assessing medical decision making capacity among cancer patients : Preliminary clinical experience of using a competency assessment instrument
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评估癌症患者的医疗决策能力：使用能力评估工具的初步临床经验
DOI：
10.1017/s1478951513000588
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发表时间：
2013
影响因子：
2.2
通讯作者：
et al
中科院分区：
文献类型：
--
作者：
Akechi T;et al
目的探讨结构化访谈对癌症患者胜任力和不胜任力评估测试和排名量表（sicatri）的有效性，该量表是一种评估患者临床实践胜任力的结构化访谈。方法SICIATRI最初是为了测量患者的知情同意能力而开发的，对需要评估医疗决策能力的转诊癌症患者进行了研究。回顾性研究了sicatri的有效性。如果适用，研究小组提出了对癌症患者的sicatri进行修改的建议。结果在433例转诊的癌症患者中，12例患者接受了SICIATRI治疗，治疗过程均无大问题。所有患者年龄均在60岁及以上。能力评估最常见的目的是分析患者对肿瘤医生提出的抗癌治疗方案的理解程度，其次是患者对治疗方案的拒绝程度。一半的患者（n = 6）被诊断为谵妄，其中3人被判定为患者能力受损最严重的状态。两名患者（17%）被诊断为重度抑郁症，另外两名患者（17%）被诊断为智力低下，每名患者均被诊断为痴呆和既往酒精依赖史。在6例无谵妄的患者中，包括1例痴呆患者在内的5例受试者被判定完全胜任。共推荐了5个潜在的SICIATRI小修改以用于日本癌症患者。结果的意义我们的经验表明，sicatri是一个有用的工具，心理肿瘤的临床实践。
ObjectThis 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.MethodsThe 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.ResultsAmong 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.Significance of resultsOur experience suggests that the SICIATRI is a useful instrument for psycho-oncology clinical practice.