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Capacity Assessment Instrument (CAI-H)

Portuguese version (original)

Amaral, A. S., Simões, M. R., Freitas, S., & Afonso, R. M. (2021). Instrumento de Avaliação da Capacidade - Saúde (IAC-S) [Capacity Assessment Instrument – Health (IAC-H)]. Coimbra: Laboratório de Avaliação Psicológica e Psicometria (PsyAssessmentLab), Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra.

Theoretical background

Capacity Assessment Instrument – Health (IAC-H) enables the evaluation of decision-making regarding one’s own health. Its development has as theoretical background Grisso and Appelbaum’s (1998) model, whereby decision-making capacity in healthcare relies on four abilities (understanding, appreciation, reasoning and communicating a choice) (see also Palmer & Harmell, 2016).

Being dependent on cognitive functioning, health care decision-making is compromised in cases of severe cognitive impairment. However, this capacity may be preserved in mild cognitive impairment and early stages of dementia (Carabellese et al., 2017; Okonkwo et al., 2007). Therefore, cognitive impairment does not invariably imply the absence of capacity to make decisions regarding healthcare, which highlights the need of specific tool that allows its assessment.

Description

Assessment Domain: Abilities implied in healthcare decision-making capacity, specifically, understanding, appreciation, reasoning and communicating a choice.

Application: Structured interview after the presentation of clinical vignettes.

Population: ≥ 60 (Adult): a) control group; b) group diagnosed with mild cognitive impairment; and c) group diagnosed with mild Alzheimer’s disease.

Contacts

Ana Paula Amaral (anapaula@fcsaude.ubi.pt)

References

  1. Amaral, A. P. (2023). Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde - Desenvolvimento e validação do IAC-Saúde [Assessment of Decision-Making Capacity in Health Care - Development and validation of the CAI-Health]. Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra. Ph.D thesis. Psychology/Neuropsychology. [FCT, Ph. D Grant, ref. SFRH/BD/139344/2018].
  2. Amaral, A. P., Simões, M. R., Freitas, S., & Afonso, R. M. (2023). Development of clinical vignettes to assess healthcare decision-making capacity in elderly with mild cognitive impairment and Alzheimer's disease. European Review of Applied Psychology, 73(3), https://doi.org/10.1016/j.erap.2022.100799
  3. Amaral, A. P., Simões, M. R., Freitas, S., & Afonso, R. M. (2024, in press). Capacity Assessment Instrument – Health: Pilot Study of a New Tool for Adults with Dementia. Clinical Gerontologist. https://doi.org/10.1080/07317115.2024.2331171
  4. Amaral, A. S., Afonso, R. M., Simões, M. R., & Freitas, S. (2018). Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde (IACTD-CS): Processo de Desenvolvimento [Instrument for the Assessment of Decision-Making Capacity in Health Care (IACTD-CS): Development Process]. Comunicação apresentada ao 4º Congresso da Ordem dos Psicólogos Portugueses. Braga, 12 de setembro de 2018
  5. Amaral, A. S., Afonso, R. M., Simões, M. R., & Freitas, S. (2021). Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia. Psychiatric Quarterly. https://doi.org/10.1007/s11126-020-09867-7
  6. Amaral, A. S., Simões, M. R., Freitas, S., Vilar, M., Sousa, L. B., & Afonso, R. M. (2022). Healthcare decision-making capacity in old age: A qualitative study. Frontiers in Psychology, 13:1024967. https://doi.org/10.3389/fpsyg.2022.1024967
  7. Appelbaum, P. S., & Grisso, T. (1988). Assessing Patients’ Capacities to Consent to Treatment. New England Journal of Medicine, 319(25), 1635–1638. https://doi.org/10.1056/NEJM198812223192504
  8. Carabellese, F., Felthous, A. R., La Tegola, D., Piazzolla, G., Di staso, S., Logroscino, G., Leo, A., Ventriglio, A., & Catanesi, R. (2017). Qualitative analysis of the capacity to consent to treatment in patients with a chronic neurodegenerative disease: Alzheimer’s disease. International Journal of Social Psychiatry, 64(1), 26–36. https://doi.org/10.1177/0020764017739642
  9. Okonkwo, O. C., Griffith, H. R., Belue, K., Lanza, S., Zamrini, E. Y., Harrell, L. E., Brockington, J. C., Clark, D., Raman, R., & Marson, D. C. (2007). Medical decision-making capacity in patients with mild cognitive impairment. Neurology, 69, 1528–1535. https://doi.org/10.1212/01.wnl.0000277639.90611.d9
  10. Palmer, B. W., & Harmell, A. L. (2016). Assessment of Healthcare Decision-making Capacity. Archives of Clinical Neuropsychology, 31, 530–540. https://doi.org/10.1093/arclin/acw051