Table 1 Comparison of tools to assess decision-making capacity

Measure of Understanding (MUA) (Schachter et al. 2011)

Developed by physicians, bioethicists, adolescents with ADHD, and adolescents’ parents

Patients provided information about stimulant medication, then interviewed with 8 open ended questions modeled after the MacCAT-T, followed by 42 multiple choice questions, to assess understanding of ADHD, ADHD treatment, medication benefits, side effects, alternatives

Understanding

Total composite score of interview and multiple choice questions with maximum attainable score of 100.

Measure of Competence (MOC) (Weithorn et al. 1982)

Developed by clinicians and attorneys

Patients provided with a series of four clinical vignettes with hypothetical treatment dilemmas, then interviewed to assess their understanding of the clinical dilemma, ability to provide rational reasons for their choices, and create a reasonable outcome.

Scale of Reasonable Outcome, Scale of Rational Reasons, Understanding (Rote Recall – measures understanding of facts, and Inference – measures appreciation)

Understanding scored from 0–2, Scale of Reasonable Outcome scored from 1–5, Scale of Rational Reasons scored variably based on clinical vignette with points allocated for degree of thought behind decisions.

MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (Grisso et al. 1997)

Developed by Grisso et al. based on previous studies of decision-making competence

Semi-structured interview with patients, starting with disclosure of the patient’s conduction, followed by questions pertaining to the benefits and risks of, and alternatives to the recommended treatment. Questions are designed to assess the four elements of capacity. Finally, the patient expresses a choice.

Understanding, reasoning, appreciation

Understanding scored from 0–6, reasoning from 0–8, and appreciation from 0–4. No cut-offs provided for determination of decision-making capacity.