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Background <p>This study aimed to validate the Competence Assessment Tool for Advance Directives (CAT-AD), designed to support the assessment and clinical judgment of an individual’s competence to complete an advance directive, particularly in cases of cognitive impairment such as early-stage dementia.</p> Methods <p>A cross-sectional study was conducted to evaluate the CAT-AD, based on the MacArthur Competence Assessment Tool for Treatment framework. The study was conducted in two memory clinics, focusing on patients with cognitive impairments. Thirty-one memory clinic patients with varying levels of cognitive impairment participated. The CAT-AD assesses four subscales: Understanding, Appreciation, Reasoning, and Expressing a&#xa0;choice. These subscales were tested for their ability to predict clinical judgments of competence. Divergent validity was assessed against measures of cognitive impairment, depression, health literacy, and education level. Internal consistency was measured using Cronbach’s α.</p> Results <p>All CAT-AD subscales significantly predicted competence, with higher scores increasing the likelihood (odds ratio 2.5–6.9) of being judged competent. Subscales were unrelated to depression or education, suggesting the CAT-AD assesses a&#xa0;distinct construct. All subscales correlated with health literacy, and only Reasoning and Appreciation did not predict cognitive impairment. Internal consistency was satisfactory (Cronbach’s α &gt; 0.70).</p> Conclusion <p>The CAT-AD is a&#xa0;reliable and valid tool for assessing competence to complete an advance directive. Future research should expand its validation across different legal standards and clinical settings to enhance its generalizability.</p>

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Development and validation of the CAT-AD: a competence assessment tool for advance directives

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月15日

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  • Gregor Lindl,
  • Jonas Karneboge,
  • Paul S. Appelbaum,
  • Tanja Müller,
  • Daniel Garmann,
  • Tarik Karakaya,
  • David Prvulovic,
  • Julia Haberstroh

摘要

Background

This study aimed to validate the Competence Assessment Tool for Advance Directives (CAT-AD), designed to support the assessment and clinical judgment of an individual’s competence to complete an advance directive, particularly in cases of cognitive impairment such as early-stage dementia.

Methods

A cross-sectional study was conducted to evaluate the CAT-AD, based on the MacArthur Competence Assessment Tool for Treatment framework. The study was conducted in two memory clinics, focusing on patients with cognitive impairments. Thirty-one memory clinic patients with varying levels of cognitive impairment participated. The CAT-AD assesses four subscales: Understanding, Appreciation, Reasoning, and Expressing a choice. These subscales were tested for their ability to predict clinical judgments of competence. Divergent validity was assessed against measures of cognitive impairment, depression, health literacy, and education level. Internal consistency was measured using Cronbach’s α.

Results

All CAT-AD subscales significantly predicted competence, with higher scores increasing the likelihood (odds ratio 2.5–6.9) of being judged competent. Subscales were unrelated to depression or education, suggesting the CAT-AD assesses a distinct construct. All subscales correlated with health literacy, and only Reasoning and Appreciation did not predict cognitive impairment. Internal consistency was satisfactory (Cronbach’s α > 0.70).

Conclusion

The CAT-AD is a reliable and valid tool for assessing competence to complete an advance directive. Future research should expand its validation across different legal standards and clinical settings to enhance its generalizability.