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Decision-Making Competence, Aging and Mental Status
The term competence in decision making is often linked to the phrase legal competence. Here, for example, a judge may go by a patient's bedside to determine if the patient is legally competent to make a medical decision on his or her own behalf. The term decisional capacity and notions related to the assessment of decisional capacity belong to the realm of physicians in two areas: (1) assessing the capabilities of patients to make medical decisions in medical care and (2) assessing the capabilities of individuals to make decisions on whether to participate in human research studies as study volunteers. This entry provides an overview of decisional capacity; addresses the role of physicians in assessing decisional capacity of patients; discusses various assessment procedures for patients, including aging patients and patients with compromised mental states; and closes with a brief look at the implications for future research.
Overview
Decisional capacity is often phrased as being a question of whether a particular individual has the ability to make choices on his or her own behalf. It has been argued that decisional capacity itself has many components, including but not limited to cognition, memory, mood, emotion, and valuation, among others, which can be affected by age and/or mental status. But the above definition overstates the concept of decisional capacity because—even if all components are intact in an individual—in reality very few individuals make decisions solely on their own behalf.
In reality, individuals come to and make choices after considering opinions from others and make decisions of accepting or rejecting alternatives offered to them from a set of options on the basis of the opinions of others in any number of areas: on what to base a decision, on how to choose among a set of alternatives, and on how much to value a benefit in the context of related harms. And all this information is received and processed into a decision where it is virtually impossible to ensure that all intentional or nonintentional attempts to manipulate the information are able to be identified and extracted from the information and the decision. This extraction of manipulated information is essential in any decision that is worth making.
Physician Assessment
Medical Decision Making
In medical decision making—in absence of an emergency where the individual needs to be acted upon medically to save his or her life, with that emergency further characterized as lacking an advance directive developed and signed by this patient at some time before the emergent event—an individual has three options open to him or her when offered a medical opinion. First, the individual can accept the proffered opinion. Second, the individual can reject the proffered opinion. Third, the individual can elect to delay choice until a later time in the hope that something will be developed scientifically (or that more understanding will be gained scientifically) before the medical condition or disease under consideration takes the upper hand in the individual and before that medical condition reaches a state where it can no longer be reasonably eliminated, slowed, or otherwise managed medically no matter what attempts are made to do so.
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- Basis for Making the Decision
- Acceptability Curves and Confidence Ellipses
- Beneficence
- Bioethics
- Choice Theories
- Construction of Values
- Cost-Benefit Analysis
- Cost-Comparison Analysis
- Cost-Consequence Analysis
- Cost-Effectiveness Analysis
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- Costs, Spillover
- Economics, Health Economics
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- Efficient Frontier
- Health Outcomes Assessment
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- Health Status Measurement, Construct Validity
- Health Status Measurement, Face and Content Validity
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- Health Status Measurement, Generic Versus Condition-Specific Measures
- Health Status Measurement, Minimal Clinically Significant Differences, and Anchor Versus Distribution Methods
- Health Status Measurement, Reliability and Internal Consistency
- Health Status Measurement, Responsiveness and Sensitivity to Change
- Human Capital Approach
- Life Expectancy
- Morbidity
- Mortality
- Oncology Health-Related Quality of Life Assessment
- Outcomes Research
- Patient Satisfaction
- Regret
- Report Cards, Hospitals and Physicians
- Risk Adjustment of Outcomes
- SF-36 and SF-12 Health Surveys
- SF-6D
- Sickness Impact Profile
- Sunk Costs
- Impact or Weight or Utility of the Possible Outcomes
- Certainty Equivalent
- Chained Gamble
- Conjoint Analysis
- Contingent Valuation
- Cost Measurement Methods
- Decomposed Measurement
- Disability-Adjusted Life Years (DALYs)
- Discounting
- Discrete Choice
- Disutility
- EuroQol (EQ-5D)
- Health Utilities Index Mark 2 and 3 (HUI2, HUI3)
- Healthy Years Equivalents
- Holistic Measurement
- Multi-Attribute Utility Theory
- Person Trade-Off
- Quality of Well-Being Scale
- Quality-Adjusted Life Years (QALYs)
- Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST)
- SMARTS and SMARTER
- Split Choice
- Utilities for Joint Health States
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- Artificial Neural Networks
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- Constraint Theory
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- Ethnographic Methods
- Expert Systems
- Patient Decision Aids
- Qualitative Methods
- Story-Based Decision Making
- Support Vector Machines
- Team Dynamics and Group Decision Making
- Threshold Technique
- Perspective of the Decision Maker
- Advance Directives and End-of-Life Decision Making
- Consumer-Directed Health Plans
- Cultural Issues
- Data Quality
- Decision Making in Advanced Disease
- Decisions Faced by Hospital Ethics Committees
- Decisions Faced by Institutional Review Boards
- Decisions Faced by Nongovernment Payers of Healthcare: Managed Care
- Decisions Faced by Patients: Primary Care
- Decisions Faced by Surrogates or Proxies for the Patient, Durable Power of Attorney
- Diagnostic Process, Making a Diagnosis
- Differential Diagnosis
- Evaluating and Integrating Research Into Clinical Practice
- Evidence Synthesis
- Evidence-Based Medicine
- Expert Opinion
- Genetic Testing
- Government Perspective, General Healthcare
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- Informed Decision Making
- International Differences in Healthcare Systems
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- Medicare
- Models of Physician–Patient Relationship
- Patient Rights
- Physician Estimates of Prognosis
- Rationing
- Religious Factors
- Shared Decision Making
- Surrogate Decision Making
- Teaching Diagnostic Clinical Reasoning
- Technology Assessments
- Terminating Treatment, Physician Perspective
- Treatment Choices
- Trust in Healthcare
- The Psychology Underlying Decision Making
- Accountability
- Allais Paradox
- Associative Thinking
- Attention Limits
- Attraction Effect
- Automatic Thinking
- Axioms
- Biases in Human Prediction
- Bounded Rationality and Emotions
- Certainty Effect
- Cognitive Psychology and Processes
- Coincidence
- Computational Limitations
- Confirmation Bias
- Conflicts of Interest and Evidence-Based Clinical Medicine
- Conjunction Probability Error
- Context Effects
- Contextual Error
- Counterfactual Thinking
- Cues
- Decision Making and Affect
- Decision Modes
- Decision Psychology
- Decision Weights
- Decision-Making Competence, Aging and Mental Status
- Deliberation and Choice Processes
- Developmental Theories
- Dual-Process Theory
- Dynamic Decision Making
- Editing, Segregation of Prospects
- Emotion and Choice
- Errors in Clinical Reasoning
- Experience and Evaluations
- Fear
- Frequency Estimation
- Fuzzy-Trace Theory
- Gain/Loss Framing Effects
- Gambles
- Hedonic Prediction and Relativism
- Heuristics
- Human Cognitive Systems
- Information Integration Theory
- Intuition Versus Analysis
- Irrational Persistence in Belief
- Judgment
- Judgment Modes
- Learning and Memory in Medical Training
- Lens Model
- Lottery
- Managing Variability and Uncertainty
- Memory Reconstruction
- Mental Accounting
- Minerva-DM
- Mood Effects
- Moral Factors
- Motivation
- Numeracy
- Overinclusive Thinking
- Pain
- Pattern Recognition
- Personality, Choices
- Preference Reversals
- Probability Errors
- Probability, Verbal Expressions of
- Problem Solving
- Procedural Invariance and Its Violations
- Prospect Theory
- Range-Frequency Theory
- Risk Attitude
- Risk Aversion
- Risk Communication
- Risk Perception
- Scaling
- Social Factors
- Social Judgment Theory
- Stigma Susceptibility
- Support Theory
- Uncertainty in Medical Decisions
- Unreliability of Memory
- Value Functions in Domains of Gains and Losses
- Worldviews
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