A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare

Abstract

Background: Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. Methods: Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. Results: Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to threequarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains.

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

“…Other statistically significant correlations with having impaired DMC were having a diagnosis of schizophrenia spectrum and other psychotic disorders ( p = 0.0007) and being admitted involuntarily ( p < 0.0001). From the logit model patients with schizophrenia spectrum disorders and involuntary admission were at a significantly higher risk not to have DMC, and this is in keeping with what has previously been reported ( 6 , 42 , 46 , 47 ). Decisional incapacity in patients with psychotic disorders is responsive to interventions, such as simplification of the information, encouragement, and shared decision-making ( 46 ).…”

“…From the logit model patients with schizophrenia spectrum disorders and involuntary admission were at a significantly higher risk not to have DMC, and this is in keeping with what has previously been reported ( 6 , 42 , 46 , 47 ). Decisional incapacity in patients with psychotic disorders is responsive to interventions, such as simplification of the information, encouragement, and shared decision-making ( 46 ).…”

“…Most of the literature focus on the duration of untreated illness and the effect on prognosis or other outcome measures. Patients with schizophrenia have been found to have an increased risk of a dementia diagnosis and it has been found that people with younger age of mental disorder onset and more persistence of mental disorders, has accelerated aging in midlife, including impairments in sensory, motor and cognitive functioning (44,45). Other statistically significant correlations with having impaired DMC were having a diagnosis of schizophrenia spectrum and other psychotic disorders (p = 0.0007) and being admitted involuntarily (p < 0.0001).…”

“…Encouragement and shared decision making are also considered essential. Training in and implementation of these measures to enhance autonomous DMC can ultimately reduce the stigma associated with SMI in older populations ( 39 , 46 ).…”

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

“…In consequence, their decision-making capacity varies over time and with the type of decision to be made [3,5]. Several studies reveal that schizophrenia and bipolar disorder patients retain the capacity to make treatment and other healthcare-related decisions despite impairments at some stages of the illness, and this can be fully recovered after treatment [6]. Supporting mental illness patients' decisional capacity is crucial as it leads to improved health outcomes and patients' health-related quality of life [7][8][9].…”