BMJ 1999;318:1765 ( 26 June )

Letters

Assessment of competence to complete advance directives

    Standardised instruments are needed to guide the measurement of competence
    Authors' reply

Standardised instruments are needed to guide the measurement of competence

The first 150 words of the full text of this article appear below.

EDITOR---Fazel et al described an instrument for the assessment of competency to complete advance directives that seems to be reliable, valid, and ready for use in clinical practice.1 We believe, however, that certain aspects require clarification before the clinical usefulness of the test is assured.

Firstly, who is this test meant for? Different groups are suggested in different parts of the text. Is it meant to differentiate between competency and incompetency in demented patients, in the broader group of patient with cognitive impairment, or in elderly volunteers? If the test aims to assess competency in dementia, test-retest analysis should include only data on demented patients, because fluctuations in functioning in this group are more common. The reported test-retest correlation was mainly based on data on non-demented subjects, and there is a likelihood of overestimation of the reliability of the test for demented subjects.

The test discriminated between non-demented . . . [Full text of this article]
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Relevant Article

Assessment of competence to complete advance directives: validation of a patient centred approach
Seena Fazel, Tony Hope, and Robin Jacoby
BMJ 1999 318: 493-497. [Abstract] [Full Text] [PDF]

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