FORMAL ASSESSMENT TOOLS
In addition to or instead of a directed clinical interview, a formal, structured assessment tool can be used to evaluate capacity. Two such tools are the Aid to Capacity Evaluation (ACE)3,12 and the MacArthur Competence Assessment Tool (MacCAT).1 Both use standardized questions and scoring systems to achieve a more objective assessment of capacity than an interview. The abilities assessed, however, are the same as those assessed in a clinical interview and the scores still require interpretation by an evaluator. The MacCAT is a lengthy, comprehensive tool designed for patients with complex psychiatric or neurologic conditions whose capacity determination is especially difficult. The assessment can be administered and scored in approximately 30 minutes. The ACE (Figure 2) is a short, more clinically oriented tool that can be administered and scored in five to 10 minutes. The ACE can also be found on the Web site of the University of Toronto Joint Centre for Bioethics:http://www.utoronto.ca/jcb/_ace. General instructions are simple: clinicians are directed to address communication barriers, discuss treatment information and answer patient questions before administering the assessment.
FORMAL ASSESSMENT TOOLSIn addition to or instead of a directed clinical interview, a formal, structured assessment tool can be used to evaluate capacity. Two such tools are the Aid to Capacity Evaluation (ACE)3,12 and the MacArthur Competence Assessment Tool (MacCAT).1 Both use standardized questions and scoring systems to achieve a more objective assessment of capacity than an interview. The abilities assessed, however, are the same as those assessed in a clinical interview and the scores still require interpretation by an evaluator. The MacCAT is a lengthy, comprehensive tool designed for patients with complex psychiatric or neurologic conditions whose capacity determination is especially difficult. The assessment can be administered and scored in approximately 30 minutes. The ACE (Figure 2) is a short, more clinically oriented tool that can be administered and scored in five to 10 minutes. The ACE can also be found on the Web site of the University of Toronto Joint Centre for Bioethics:http://www.utoronto.ca/jcb/_ace. General instructions are simple: clinicians are directed to address communication barriers, discuss treatment information and answer patient questions before administering the assessment.
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