Psychometric instruments to assess decision-making skills in clinical-legal settings: A scoping review

The assessment of decision-making capacity in patients with severe and persistent psychiatric disorders constitutes a highly complex clinical, ethical, and legal challenge. This scoping review aimed to identify, describe, and analyze the main psychometric instruments used to assess decision-making capacity in diverse clinical settings. To this end, a systematic literature search was conducted in specialized databases (PubMed, Scopus, SciELO, PsycINFO, and Web of Science) following the methodological guidelines of the Joanna Briggs Institute (JBI). Sixteen studies published between 2015 and 2025 were selected after applying rigorous inclusion and exclusion criteria.

The results show that the most widely used instrument is the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), due to its comprehensive approach to the domains of comprehension, appreciation, reasoning, and expression of choice. Other relevant instruments were also identified, such as the Aid to Capacity Evaluation (ACE), the UBACC, and the CCTI, each with particular strengths depending on the context of application. However, important limitations persist, such as the lack of cultural adaptations and poor standardization in Spanish-speaking populations. Furthermore, it is concluded that the available instruments are useful and reliable, but their effective application requires careful integration with clinical protocols, adequate staff training, and ethical and legal considerations. As such, the study contributes to clarifying the current landscape of tools available for assessing decision-making capacity, highlighting their importance in protecting patient autonomy in highly vulnerable contexts.