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Am J Geriatr Psychiatry 15:168-173, February 2007
© 2007 American Association for Geriatric Psychiatry
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Brief Report

Agreement Between Instruments for Rating Treatment Decisional Capacity

Ronald J. Gurrera, M.D., Michele J. Karel, Ph.D., Armin R. Azar, M.A., and Jennifer Moye, Ph.D.

From the Mental Health Service, VA Boston Healthcare System, Boston, MA, and Harvard Medical School Department of Psychiatry, Boston, MA (RJG, MJK, JM); and the Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY (ARA).

Objective: The objective of this study was to measure agreement between three treatment decisional capacity assessment instruments in mild to moderate dementia.

Method: Subjects (N=79) were recruited from the community. Rating agreement was evaluated with kappa statistics.

Results: Three-way agreement was fair for overall capacity ({kappa}=0.451), very good for understanding (0.618), very poor for choice (0.158), and no better than chance for reasoning and appreciation. Pairwise agreement showed a similar pattern.

Conclusions: With the exception of understanding, current treatment decisional capacity assessment instruments do not consistently agree with one another in assessing treatment decision abilities.

Key Words: Treatment decisions • decisional capacity • interrater agreement




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