A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare
Por:
Calcedo-Barba A, Fructuoso A, Martinez-Raga J, Paz S, Sánchez de Carmona M and Vicens E
Publicada:
30 jun 2020
Ahead of Print:
30 jun 2020
Categoría:
Psychiatry and mental health
Resumen:
Background Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. Methods Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. Results Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains. Conclusions Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.
Filiaciones:
Calcedo-Barba A:
Department of Psychiatry, Hospital Gregorio Marañón
Medical School, Universidad Complutense de Madrid, Doctor Esquerdo 46, 28007, Madrid, Spain.
Fructuoso A:
Adult Psychiatry Service and Geneva Penal Medicine Division, Geneva University Hospitals, Puplinge, Switzerland
:
Psychiatry Service, University Hospital Doctor Peset, University of Valencia, Valencia, Spain
Paz S:
SmartWriting4U, Valencia, Spain
Sánchez de Carmona M:
Medical School, Universidad Anáhuac, Mexico City, Mexico
Vicens E:
Department of Psychiatry, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
Green Published, gold, Green Submitted
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