[Assesment of patient competence in psychiatry: an overview of recent instruments]

Determining decision-making capacity is a difficult and complex process. Although the MacArthur Competence Assessment Tool (MacCAT) is widely considered the gold standard for capacity assessment, it suffers from shortcomings.

To identify recently published instruments for assessing decision-making capacity of psychiatric patients and to determine whether these can provide added value compared to the MacCAT.

A systematic literature review of instruments for assessing patients’ decision-making capacity was conducted via PubMed, Embase, and Scopus.

Seven instruments were identified. These were all based on the four cognitive criteria (understanding, appreciation, logical reasoning, and expressing choice) that are considered, by consensus, to be necessary to assess decision-making capacity. However, two of these (relational-ethical model and U-Doc) offer added value by embracing very different basic principles when determining decision-making capacity, such as ethics and the social support of the patient. Next to cognitive factors, the patient’s personal context and possible bias on the part of the assessor are also taken into account.

Although the MacCAT is still considered to be the gold standard, two recently developed instruments (relational-ethical model and U-Doc) offer an opportunity to overcome some of the shortcomings of this scale.