The Hopkins Competency Assessment Test (HCAT) can be used to help determine if a patient is competent to make medical decisions and to prepare an advance directive.


(1) The person is given a short essay on the process of advance directives. Several versions are available based on the person's level of reading comprehension.

(2) The person is then asked a series of questions to see how well they understood what they just read.

(3) If a person did not show comprehension at a given reading level, then the test was repeated at a lower reading level, if not previously used.

(4) A person judged competent can then proceed with the process of specifying his or her advance directive.


Topics for the Essay:

(1) Before a doctor can do a procedure, the doctor must tell the patient what he or she will do, what can go right, what can go wrong, and what alternatives to the procedure there are.

(2) The patient has the right to refuse the procedure.

(3) A sick person may not be able to think clearly and may not be able to understand what the doctor is saying. That person may not be able to tell the doctor what he or she wants done.

(4) The person when still healthy can write down what she or he wants done and what is not to be done. The patient can designate someone who can make decisions for him or her if he or she is unable to. This set of instructions is called a durable power of attorney.


The instrument (from Table 2, page 134) has 6 questions with 10 possible responses, each of which is scored 0 or 1 point.


score for HCAT =

= SUM(points for all 10 responses)



• minimum score: 0

• maximum score: 10

• Patients who were felt clinically competent had scores of 4-10, while patients who were clinically incompetent had scores of 0-3.

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