The Psychometric Properties of the Competency Interview Schedule

Abstract

One of the most contentious issues in medical and legal practice is how to reliably assess the mental competence of individuals who consent or refuse psychiatric treatment. Current legislation does not provide clear definitions of what constitutes competence or incompetence to make a treatment decision. As a preliminary attempt to operationalize the concept of competency, we have developed a 15 item questionnaire. The present study reports on the psychometric properties of the instrument. Test-retest and interrater reliability results were good. The instrument was internally consistent and discriminated between individuals found competent and incompetent by the treating physician.

Assessment of patient capacity to consent to treatment

“…9 The Competency Interview Schedule had good reliability when administered to depressed patients by two trained research assistants. 7 We have extended these results by showing that trained medical students and residents can reliably administer a specific capacity assessment to medical patients undergoing a broad range of treatment decisions, and these assessments agree closely with expert assessments.…”

“…5 Some existing measures of specific capacity have not been evaluated on patients, 6 while others have been evaluated by trained researchers and experts on patients making decisions about specific psychiatric treatments. [7][8][9] There are no studies of specific capacity assessment that use the treating clinician as the assessor, and no studies that focus on medical patients who are facing actual decisions about medical treatment.…”

Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses

“…1) (Weinstock et al 1984;Veliz & James, 1987;Norko et al 1990;Bean et al 1994;Grisso et al , 1997Carpenter et al 2000;Moser et al 2002Moser et al , 2005Moser et al , 2006Valletto et al 2002;Wong et al 2000Wong et al , 2005Bellhouse et al 2003;Kovnick et al 2003;Vollmann et al 2003;Cohen et al 2004;Palmer et al 2004Palmer et al , 2005Srebnik et al 2004;Cairns et al 2005;Eyler et al 2005Eyler et al , 2007Koren et al 2005;Stroup et al 2005;Candilis et al 2006Candilis et al , 2008Dunn et al 2007;Moye et al 2008;Kavanagh et al 2008;Jeste et al 2009;Owen et al 2009aOwen et al , 2011De Marco et al 2010;Capdevielle et al 2009;Linder et al 2012;Di & Cheng, 2013;Fischer et al 2013;Kumar et al 2013;Lan et al 2013;Raffard et al 2013;Skipworth et al 2013;Chiu et al 2014). A clinician with expertise in the field [G Shields (GS)] ...…”

“…Characteristics and results from all studies providing data on 'judgement standard' or 'cut-off standard' of assessment are presented in Table 2 ( Chiu et al 2014 andNorko et al 1990 are excluded and considered separately below). The range of proportions of DMC-T reported by all studies is large (11-100%) and there is significant heterogeneity between studies: six studies recruited from inpatient settings (Veliz & James, 1987;Bean et al 1994;Bellhouse et al 2003;Vollmann et al 2003;Cairns et al 2005;Owen et al 2009aOwen et al , 2011Di & Cheng, 2013), one from outpatients (Moye et al 2008), two from mixed inpatients and outpatient settings (Wong et al 2000;Skipworth et al 2013), and one from a general medical hospital setting (Weinstock et al 1984). Seven studies assessed DMC-T for a decision that was related to the disorder (hospital admission or treatment for schizophrenia) (Veliz & James, 1987;Bean et al 1994;Bellhouse et al 2003;Vollmann et al 2003;Cairns et al 2005;Owen et al 2009aOwen et al , 2011Di & Cheng, 2013;Skipworth et al 2013); two assessed DMC-T for medical treatment unrelated to schizophrenia (Weinstock et al 1984;Moye et al 2008); and one assessed DMC-T for treatment with an unclear relationship to schizophrenia (Wong et al 2000).…”

“…Two studies assessed DMC-T as a naturalistic study in which people were recruited following concerns regarding a lack of DMC-T having been raised (Weinstock et al 1984;Veliz & James, 1987). It was only within the set of studies recruiting from inpatient settings that there were two or more studies sufficiently comparable with each other in terms of recruitment setting and nature of decision for which DMC-T was assessed in order to be eligible to undergo meta-analysis (Bean et al 1994;Bellhouse et al 2003;Cairns et al 2005;Owen et al 2009aOwen et al , 2011Di & Cheng, 2013). These studies assessed DMC-T for psychiatric admission and/or treatment in hospital with medication or ECT; three were UK-based and used the MCA legal standard.…”