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Capacity Evaluation Requests in the Medical Setting: A Retrospective Analysis of Underlying Psychosocial and Ethical Factors

机译：医学环境中的能力评估请求：对潜在的心理社会和道德因素的回顾性分析

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Background: Psychosocial and ethical variables influence physicians in requesting decision-making capacity (DMC) evaluations. Previous authors have classified certain DMC evaluation requests as "unwarranted" when there is no explicit suspicion or evidence that the patient might lack DMC. Objective: To explore psychosocial and ethical reasons motivating both "warranted" and "unwarranted" DMC evaluation requests by physicians in the medical setting. Methods: A retrospective electronic health record review was approved by the institutional review board. All psychiatric consultation requests idented as DMC evaluation requests between January 1, 2012 and December 31, 2012 were assessed independently by 2 reviewers. Each reviewer identified each DMC evaluation request as "warranted" vs "unwarranted" Unwarranted DMC evaluation requests were defined as those lacking explicit suspicion that the patient might lack DMC or those with explicit evidence of a patient with blatantly impaired DMC We hypothesized that most (over half) DMC evaluation requests would be deemed unwarranted. Descriptive statistics, chi-squarelFisher exact tests, and t-testl ANOVA were used Results: A total of 146 DMC evaluations were reviewed, and 83 (56.8%) of these were deemed unwarranted. Of these, most were likely driven by a previous neuropsychiatric disturbance (p < 0.001). Various other psychosocial and ethical patterns were identified (i.e., the practice of defensive medicine and guardianship concerns). Conclusion: Over half of DMC evaluation requests in a general medical setting were unwarranted. Many such requests were motivated by unarticulated psychosocial and ethical factors. DMC evaluation requests appear to serve as a means for indirectly resolving various psychosocial and ethical dilemmas beyond assessing DMC itself. Implications and future directions are discussed.
机译：背景：心理社会和道德变量在要求决策能力（DMC）评估时影响医生。以前的作者将某些DMC评估请求分类为“无名的”，当没有明确的怀疑或证据表明患者可能缺乏DMC时。目的：探讨心理社会和伦理原因，激励医生在医疗环境中的医生“有保证”和“无根据”DMC评估请求。方法：回顾性电子健康记录评论由机构审查委员会批准。所有精神病学咨询征求要求在2012年1月1日至2012年12月31日之间的DMC评估请求被2次审稿人独立评估。每次审稿人都确定了“保证”的每个DMC评估请求，VS“UNRANTARED”无名的DMC评估请求被定义为缺乏明确怀疑的人，即患者可能缺乏DMC或具有公然受损DMC的患者明确证据的人，我们假设大多数人（结束）一半）DMC评估请求将被视为无根据。描述性统计数据，Chi-Squarefisher精确测试和T-Testl Anova结果结果：综述了146日DMC评估，其中83名（56.8％）被认为是无根据的。其中，大多数人可能被先前的神经精神紊乱驱动（P <0.001）。确定了各种其他心理社会和道德模式（即防守医学和监护担忧的实践）。结论：一半的DMC评估请求在一般医疗环境中是无人造成的。许多这样的请求是由未经化的心理社会和道德因素的激励。 DMC评估请求似乎是间接解决超出评估DMC本身的各种心理社会和道德困境的手段。讨论了含义和未来的指示。

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