{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:59:17Z","timestamp":1790067557636,"version":"4.0.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Evaluating medical decision-making capability (DMC) is critical for maintaining patient autonomy and informed consent in health care. DMC refers to a patient\u2019s ability to comprehend information about their treatment, recognize its implications, reason through the options, and articulate their decision. Several assessment techniques, including the Aid to Capacity Evaluation, the Hopkins Capacity Assessment Test (HCAT), Understanding Treatment Disclosure (UTD), and the MacArthur Competence Assessment Tool, have been discussed in this review. The legal distinction between decisional ability and competence is stressed, with courts making legal decisions based on expert testimony and healthcare providers conducting clinical assessments. The review also underlines the responsibility of physicians in assessing DMC and the need for continued monitoring in cases of shifting states such as delirium. This review emphasizes the importance of standardized training and robust tools for improving the accuracy and consistency of DMC assessments, ensuring that patient decisions are informed and autonomous.<\/jats:p>","DOI":"10.4103\/aam.aam_415_25","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:00:44Z","timestamp":1766397644000},"page":"1393-1399","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Navigating Autonomy: Enhancing Accuracy in Medical Decision-making Capacity Assessment"],"prefix":"10.4103","volume":"25","author":[{"given":"Mohammad Ajaz","family":"Alam","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Avalon University School of Medicine, Willemstad, Cura\u00e7ao"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayushi","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Trident Medical Center, North Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srishty","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Government Medical College and Hospital, Surat, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amishi","family":"Singla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dallastown Area High School, Dallastown, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baltej","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Christiana Care Union Hospital, Elkton, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Mcgillen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"R1-20260922","first-page":"40","article-title":"Evaluating medical decision-making capacity in practice","volume":"98","author":"Barstow","year":"2018","journal-title":"Am Fam Physician"},{"key":"R2-20260922","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/bioe.13121","article-title":"Importance of decisional capacity tools in obtaining informed consent in clinical settings","volume":"37","author":"Radenkovi\u0107","year":"2023","journal-title":"Bioethics"},{"key":"R3-20260922","doi-asserted-by":"crossref","first-page":"E358","DOI":"10.1001\/amajethics.2020.358","article-title":"Sliding-scale shared decision making for patients with reduced capacity","volume":"22","author":"Lahey","year":"2020","journal-title":"AMA J Ethics"},{"key":"R4-20260922","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1176\/appi.ajp-rj.2016.111105","article-title":"Revisiting decision-making capacity","volume":"11","author":"Atluru","year":"2016","journal-title":"Am J Psychiatry Residents J"},{"key":"R5-20260922","doi-asserted-by":"crossref","first-page":"971","DOI":"10.3949\/ccjm.71.12.971","article-title":"A guide to assessing decision-making capacity","volume":"71","author":"Jones","year":"2004","journal-title":"Cleve Clin J Med"},{"key":"R6-20260922","doi-asserted-by":"crossref","first-page":"559263","DOI":"10.3389\/fpsyt.2020.559263","article-title":"The role of parental capacity for medical decision-making in medical ethics and the care of psychiatrically ill youth: Case report","volume":"11","author":"Bieber","year":"2020","journal-title":"Front Psychiatry"},{"key":"R7-20260922","doi-asserted-by":"crossref","first-page":"11094","DOI":"10.15766\/mep_2374-8265.11094","article-title":"Ethics of pediatric and young adult medical decision-making: Case-based discussions exploring consent, capacity, and surrogate decision-making","volume":"17","author":"deSante-Bertkau","year":"2021","journal-title":"MedEdPORTAL"},{"key":"R8-20260922","doi-asserted-by":"crossref","first-page":"E600","DOI":"10.1001\/amajethics.2019.600","article-title":"AMA code of medical ethics\u2019 opinions related to unrepresented patients","volume":"21","author":"Chaet","year":"2019","journal-title":"AMA J Ethics"},{"key":"R9-20260922","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/15265161.2021.1941423","article-title":"Three kinds of decision-making capacity for refusing medical interventions","volume":"22","author":"Navin","year":"2022","journal-title":"Am J Bioeth"},{"key":"R10-20260922","doi-asserted-by":"crossref","first-page":"337","DOI":"10.7861\/clinmedicine.15-4-337","article-title":"Systematic review on the prevalence of lack of capacity in medical and psychiatric settings","volume":"15","author":"Lepping","year":"2015","journal-title":"Clin Med (Lond)"},{"key":"R11-20260922","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1007\/s10597-022-01046-1","article-title":"How do psychiatrists in Japan choose involuntary admission, and what do they think of supported decision making? A thematic analysis of peer to peer interviews","volume":"59","author":"Sugiura","year":"2023","journal-title":"Community Ment Health J"},{"key":"R12-20260922","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijlp.2015.04.006","article-title":"The concept of capacity in Australian mental health law reform: Going in the wrong direction?","volume":"40","author":"McSherry","year":"2015","journal-title":"Int J Law Psychiatry"},{"key":"R14-20260922","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.4103\/0972-2327.192890","article-title":"Capacity issues and decision-making in dementia","volume":"19","author":"Hegde","year":"2016","journal-title":"Ann Indian Acad Neurol"},{"key":"R15-20260922","article-title":"When is A Capacity Assessment Needed?","author":"Reger","year":"2024"},{"key":"R16-20260922","doi-asserted-by":"crossref","first-page":"afad171","DOI":"10.1093\/ageing\/afad171","article-title":"Decision-making capacity in older medical in-patients: Frequency of assessment and rates of incapacity by decision-type and underlying brain\/mind impairment","volume":"52","author":"Gan","year":"2023","journal-title":"Age Ageing"},{"key":"R18-20260922","article-title":"How do I Determine if my Patient has Decision-Making Capacity","author":"Dastidar","year":"2011","journal-title":"Others; Hospitalist"},{"key":"R19-20260922","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1001\/jama.2011.1023","article-title":"Does this patient have medical decision-making capacity?","volume":"306","author":"Sessums","year":"2011","journal-title":"JAMA"},{"key":"R20-20260922","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1080\/07317110802072140","article-title":"Assessment of capacity to consent to treatment: Challenges, the \u201cACCT\u201d approach, future directions","volume":"31","author":"Moye","year":"2007","journal-title":"Clin Gerontol"},{"key":"R21-20260922","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1093\/arclin\/acw051","article-title":"Assessment of healthcare decision-making capacity","volume":"31","author":"Palmer","year":"2016","journal-title":"Arch Clin Neuropsychol"},{"key":"R22-20260922","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1164\/rccm.202003-0512ST","article-title":"Making medical treatment decisions for unrepresented patients in the ICU. An official American Thoracic Society\/American Geriatrics Society Policy Statement","volume":"201","author":"Pope","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"R23-20260922","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1177\/0269215519852987","article-title":"Making healthcare decisions in a person\u2019s best interests when they lack capacity: Clinical guidance based on a review of evidence","volume":"33","author":"Wade","year":"2019","journal-title":"Clin Rehabil"},{"key":"R24-20260922","first-page":"299","article-title":"Can the patient decide? Evaluating patient capacity in practice","volume":"64","author":"Tunzi","year":"2001","journal-title":"Am Fam Physician"},{"key":"R25-20260922","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s11673-016-9741-1","article-title":"Documentation of capacity assessment and subsequent consent in patients identified with delirium","volume":"13","author":"Lamont","year":"2016","journal-title":"J Bioeth Inq"},{"key":"R26-20260922","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1258\/rsmmsl.48.2.113","article-title":"Mental capacity act 2005 \u2013 What do doctors know?","volume":"48","author":"Schofield","year":"2008","journal-title":"Med Sci Law"},{"key":"R27-20260922","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1111\/imj.14976","article-title":"Prevalence, types and recognition of cognitive impairment in dialysis patients in South Eastern Sydney","volume":"51","author":"Kwan","year":"2021","journal-title":"Intern Med J"},{"key":"R28-20260922","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1046\/j.1532-5415.2003.51412.x","article-title":"Health professionals\u2019 views on standards for decision-making capacity regarding refusal of medical treatment in mild Alzheimer\u2019s disease","volume":"51","author":"Volicer","year":"2003","journal-title":"J Am Geriatr Soc"},{"key":"R29-20260922","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jaclp.2024.05.004","article-title":"Assessment of decision-making capacity in 97 hospitalized patients with cancer: A call for standardization","volume":"65","author":"McFarland","year":"2024","journal-title":"J Acad Consult Liaison Psychiatry"},{"key":"R30-20260922","first-page":"95","article-title":"Audit of mental capacity assessment by primary care physicians versus consultation-liaison psychiatrists","volume":"28","author":"Chan","year":"2018","journal-title":"East Asian Arch Psychiatry"},{"key":"R31-20260922","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/014107680209501206","article-title":"How much do doctors know about consent and capacity?","volume":"95","author":"Jackson","year":"2002","journal-title":"J R Soc Med"},{"key":"R32-20260922","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1017\/S1041610219000723","article-title":"Piloting the global capacity education e-tool: Can capacity be taught to health care professionals across different international jurisdictions?","volume":"33","author":"Peisah","year":"2021","journal-title":"Int Psychogeriatr"},{"key":"R34-20260922","first-page":"e21","article-title":"Physician education on decision-making capacity assessment: Current state and future directions","volume":"63","author":"Charles","year":"2017","journal-title":"Can Fam Physician"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_415_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:00:19Z","timestamp":1790064019000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_415_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_415_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]},"assertion":[{"value":"2025-08-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}