Lesson 5. Decision making Flashcards
Is the interrater reliability in decision making in healthcare high or low?
Low, because of the lack of use of explicit judgment.
When should the capacity of decision making be assessed?
In case of decisions that (severely) harm the patient.
What are clear signs of confusion or incomprehension (onbegrip)?
- using unusual arguments
- ignoring important consequences of decisions
- incoherent answers
What are the four criteria of good decision making competence?
The ability to…
- express a choice
- understand information
- understand the situation
- reason
What are two strategies to test decision making competence?
- search for inabilities to make decisions; for example, when a patient is affected by strong emotions or doesn’t have the cognitive capacities to overview the situation.
- search for abilities (by using tests/observing).
True or false: good decision making can be tested by assessing both the outcome and the process.
False, it is only about the process (example Jehova getuigen and paranoïde man).
Which kind of tests can you use to assess the decision making competence (DMC)?
- tests to assess general functioning (Katz scale of activities of daily living)
- tests for cognitive capacity (MMSE)
- tests for decision making in general (MCATT)
Which test measures the four DCM-skills?
MacArthur Competence Assessment Tool-Treatment
What is the goal of the MCATT?
To assess the DCM.
Why is the MCATT test used for decision making competence when this test do not give a clear result?
To provide an indication of the DMC.
Extra info: without this method physicians are very reluctant to see patients as incompetent.
Families were quicker to see a family member as incompetent. Physicians using this instrument
scored inbetween.
True or false: involuntary commitment (collocatie/gedwongen opname) is only allowed when a person is a danger to him/herself or others.
True, an involuntary commitment or collocatie is a situation in which someone else chooses a treatment plan for a patient without his/her consent because of special circumstances.
Which one of the following phrases is NOT a condition for involuntary commitment?
A someone has a psychiatric disorder
B a family member/ the partner gives consent for the involuntary commitment
C this person is creating a danger for him/herself or others (the cause of this danger is the psychiatric disorder)
D other measures are not possible or effective
B: because there is no consent needed from a family member/the partner for assessing the case of involuntary commitment (gedwongen opname).
True or false: the procedure for involuntary commitment can only be started by, or under the authority of a psychiatrist or psychologist.
False, anyone can apply for this procedure at the justice of peace (vrederechter), by mentioning the name, address and the place where the person stays.
True or false: when a patient is taken into involuntary commitment, he or she does not have the same patient rights as ‘normal’ patients, such as informed consent.
False, theoretically a patient in involuntary commitment has the same rights as ‘normal’ patients, however, in practice this may be different.
