Decisional Capacity Among Youth with HIV: Results from the MacArthur Competence Tool for Treatment

Abstract

We assessed the decisional capacity (DC) of 72 youth with HIV, ages 13-24, using the MacArthur Competence Tool for Treatment, a structured interview that assesses DC along the following dimensions: understanding, appreciation, reasoning, and the ability to express a choice. Using previously established cutoff scores, results suggested 100% of youth were competent in the area of appreciation, but only 62% and 60% were competent in the areas of understanding and reasoning, respectively. Additional descriptive analyses reveal more detailed information regarding specific strengths and weaknesses within each of the dimensions of decisional capacity. These findings have important implications for health literacy initiatives, medical education, and treatment for youth with HIV, and support the need for adherence and secondary prevention interventions that include a decisional capacity component.

‘Not Until I'm Absolutely Half-Dead and Have To:’ Accounting for Non-Use of Antiretroviral Therapy in Semi-Structured Interviews with People Living with HIV in Australia

“…The capacity of individuals to make informed decisions about health care and treatment also varies, and can be influenced by age, cognitive capacity, substance dependence, and many other factors. 35,[40][41][42][43][44] Views on medications are also diverse, and can diverge dramatically from those recognized as valid or evidence based in biomedicine. However, as is well recognized in the literature, consumers have always made sense of medications in their own ways, often becoming 'naïve scientists' who generate their own conclusions about what medicines do, and even choosing to change dosages or stop using medications for a period to observe the effects.…”

“…31,[37][38][39] Other factors that influence the uptake of ART in Australia and comparable settings include an individual's capacity to make informed treatment decisions, such as health literacy and decision making ability. 40,41 Tolerance of psychological and physical distress and discomfort, 42 problems with illicit drug use, 43,44 and the views of medical providers may also influence decisions to use ART. 45,46 Although this is a broad body of literature, there have been no recent studies published that provide a more contemporary examination of the non-use of ART in a diverse sample of people with HIV.…”

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…7 Other potential factors that may play a role in youth adherence include stigma and decisional capacity. 8,9 There have been several studies of modestly successful intervention approaches for youth living with HIV who had poor medication adherence including motivational interviewing, 10 directly observed therapy, 11 personalized text message reminders, 12 and cell phone call reminders. 13 More recently, we published an initial randomized controlled trial utilizing cell phone support among nonadherent virologically detectable youth which demonstrated statistically significant improvements in self-reported adherence and reduction in HIV RNA (viral load) at the conclusion of the 24-week intervention and 24 weeks following the completion of the intervention.…”

When Does A Minor’s Legal Competence To Make Health Care Decisions Matter?

“…41,42 Weithorn and Campbell's 43 1982 study and investigations that followed the MacArthur Treatment Competence Study's work have incorporated assessment according to the legal standards of competence. [44][45][46][47][48] Whereas some research examined participants' responses to hypothetical medical vignettes in the laboratory, others evaluated the capacities of minors relative to their own decisions to participate in treatment or clinical research.…”