HOPKINS COMPETENCY ASSESSMENT TEST HCAT PDF

The HCAT represents one of the first such efforts at developing a standardized approach to evaluating the capacity to provide informed consent by providing a systematic measure of comprehension. Although primarily used in research settings, this measure has the potential to help inform clinical judgments about decision-making competence. The HCAT, developed by Jeffrey Janofsky, consists of a short description of the informed consent process and the durable power of attorney, followed by six questions e. In their validation study, Janofsky and colleagues provided interrater reliability for the HCAT by analyzing the ratings of two independent examiners on a series of 16 cases. Not surprisingly, given the simplicity of the scoring system, the authors found a correlation of. Other forms of reliability, however, have not been analyzed and are potentially less salient.

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The HCAT represents one of the first such efforts at developing a standardized approach to evaluating the capacity to provide informed consent by providing a systematic measure of comprehension. Although primarily used in research settings, this measure has the potential to help inform clinical judgments about decision-making competence. The HCAT, developed by Jeffrey Janofsky, consists of a short description of the informed consent process and the durable power of attorney, followed by six questions e.

In their validation study, Janofsky and colleagues provided interrater reliability for the HCAT by analyzing the ratings of two independent examiners on a series of 16 cases. Not surprisingly, given the simplicity of the scoring system, the authors found a correlation of. Other forms of reliability, however, have not been analyzed and are potentially less salient.

For example, because the clinical condition of many patients changes over time, test-retest reliability is not necessarily a meaningful index of scale reliability. The content validity of the HCAT has been evaluated in several research studies. For example, Jeffrey S. Barton, on the other hand, found very little concordance between HCAT scores and clinician opinions regarding competence; however, the latter were based on hospital records indicating that a patient had been considered incompetent which rarely occurred.

Subsequent studies have analyzed the association between HCAT scores and ratings of patient functional impairment, as well as performance on other measures of cognitive functioning.

For example, Sorger et al. Despite strong preliminary data in support of the reliability and validity of the HCAT, this measure is rarely used in either empirical research or clinical practice. There are numerous reasons for the limited popularity of the HCAT.

In fact, understanding of informed consent may have little association with the ability to make a rational choice among a set of complicated options. On the other hand, the HCAT has several advantages for clinical research, including brevity, ease of administration, and the generic nature of information presented.

Thus, this measure can be easily administered in the context of a battery of assessment instruments in both research and clinical settings and is applicable to all patients, regardless of health state or treatment needs. In clinical settings, the HCAT may, with further research, become a useful screening measure that can quickly identify patients who need a more thorough evaluation.

Of course, further research is clearly needed before the HCAT gains acceptance as a useful clinical or research instrument. For example, a comparison of the HCAT with more focused measures of decision-making capacity, such as the MacArthur instruments, would help clarify the relationship between the general comprehension of informed consent and the specific decision-making abilities that typically form the basis of such evaluations.

References: Barton, C. Psychiatric Services, 47, Janofsky, J. Hospital and Community Psychiatry, 43, Jones, B. Relating competency status to functional status at discharge in patients with chronic mental illness. Sorger, B. Decision-making capacity in elderly, terminally ill patients with cancer.

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