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      Face and Content Validity of the MacArthur Competence Assessment Tool for the Treatment of Iranian Patients

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          Abstract

          Background:

          There is not a valid Persian tool for measuring the decision-making competency of patients. The aim of this study is to evaluate the face and content validity of the MacArthur Competence Assessment Tool for the treatment of Iranian Persian-speaking patients.

          Methods:

          To assess the validity of the Persian version of the tool, a self-administrated questionnaire was designed. The Lawshe method was also used for assessing each item. Content validity ratio (CVR) and content validity index (CVI) were used to assess the content validity quantitatively. According to the experts’ judgment, questions with a CVR ≥0.62 and CVR <0.62 were maintainable and unmaintainable, respectively.

          Results:

          The questions were designed in a manner to achieve the desirable result (CVR ≥0.62). The CVI scale (S-CVI) and CVI (S-CVI/Ave) were 0.94 (higher than 0.79). Thus, the content validity was confirmed.

          Conclusions:

          Since capacity assessments are usually based on physician's subjective judgment, they are likely to bias and therefore, with this suitably validated tool, we can improve judgment of physicians and health-care providers in out- and in-patient cases.

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          Most cited references34

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          Enhancing informed consent for research and treatment.

          Increased scrutiny of informed consent calls for further research into decision making by patients who may be at risk for impairments. We review interventions designed to improve patient understanding of informed consent. A number of studies, within as well as outside psychiatry, have evaluated the effectiveness of specific interventions, as well as possible "predictors" of understanding of consent, such as subject characteristics, psychiatric symptoms, and cognitive impairment. Deficits in patients' understanding of informed consent may be partially related to poorly conceived, written, or organized informed consent materials; these deficits may be remediable with educational interventions. We find that effective interventions include corrected feedback, multiple learning trials, and more organized or simplified consent forms. Educational levels of patients generally correlate with levels of understanding. Even among individuals with psychiatric illness or cognitive impairment, deficits in understanding can be remedied with certain educational interventions. A variety of interventions can enhance understanding of informed consent.
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            Validity and reliability of the instruments and types of measurments in health applied researches

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              Depression and decision-making capacity for treatment or research: a systematic review

              Background Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions. Methods A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed. Results 17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured. Conclusions Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2008-7802
                2008-8213
                2017
                19 September 2017
                : 8
                : 75
                Affiliations
                [1] PhD in Medical Ethics, Kashan University of Medical Sciences, Kashan, Iran
                [1 ] Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [2 ] Department of Psychiatry, Kashan University of Medical Sciences, Kashan, Iran
                [3 ] Department of Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
                [4 ] Department of Psychology, Medical Faculty, Kashan University of Medical Sciences, Kashan, Iran
                [5 ] Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
                Author notes
                Address for correspondence: Prof. Bagher Larijani, 23# 16 Azar Ave, Keshavarz Blvd, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. E-mail: emrc@ 123456sina.tums.ac.ir
                Article
                IJPVM-8-75
                10.4103/ijpvm.IJPVM_367_16
                5634061
                52327a64-adca-4c97-bb61-b0a715385021
                Copyright: © 2017 International Journal of Preventive Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 23 October 2016
                : 08 July 2017
                Categories
                Original Article

                Health & Social care
                decision-making,informed consent,macarthur competence assessment tool,mental capacity,patient competency,validity

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