Version May 2024
| Adequate | Marginal | Inadequate | |
| Understanding | Patient recalls the content of the item and offers a fairly clear version of it. Specific use of all the terms supplied in the description is not required as long as there is no loss of meaning. | Incomplete or vague response. The patient shows some recollection of the item content but describes it in a way that renders understanding uncertain, even after the clinician has made efforts to obtain clarification. This includes responses that could indicate understanding but are too broad or vague to be sure, or responses that contain some correct pieces of information, but lack key features. | Clearly inaccurate response with serious distortion. For example, the patient does not recall the content of the item, describes it in a way that is clearly inaccurate, describes it in a way that seriously alters its meaning even after efforts to obtain clarification, or offers a response that is unrelated to the question or unintelligible. Responses citing the material verbatim with no other accompanying description do not constitute adequate understanding. |
| Expressing a choice | Patient states a clear, single choice. | Patient states more than one choice or ambivalence. | Patient is unable to state a choice at all. |
| Appreciation of the problem | Patient acknowledges that they manifest a problem based on sound reasoning. Alternatively, the patient may disagree with the claim, but must offer reasons that are not delusional and have some reasonable or verifiable explanation. | Patient acknowledges manifesting a problem but denies some features that may be considered critical for understanding or solving the problem. For example, a person who admits they only need help with opening their medications, when their problem is known to be remembering to take their medications. This rating may also be given if the patient disagrees or is ambivalent about the existence of the problem but provides reasons that are vague or not clearly defined. | Patient clearly does not believe that they have a problem with the disclosed activity. Reasoning is seriously flawed and is not based on reality or known facts. |
| Appreciation of the options | Patient acknowledges at least some potential benefit (or adverse effect) of the option on their situation that is not based on delusional or distorted thinking. Alternatively, the patient sees no benefit (or does not believe the option will have an adverse effect) and offers reasons that are not delusional or distorted to support the claim. The patient may be ambivalent but must give a clear and logical reason for being ambivalent. | Patient may or may not believe that the option will benefit (or have an adverse effect on) their situation, but the reason is vague or may represent delusional or distorted versions of reality. Alternatively, the patient is ambivalent as to the potential benefit (or harm) and the reasoning is vague. | Patient offers reasons that are delusional or a serious distortion of reality, or cannot answer the question. |
| Reasoning | Comparative: Patient provides a clear and vivid statement that compares the consequences of one option with another. Consequential: Patient provides a clear and vivid statement of how continuing with the current situation could or could not affect the patient's life. Logical consistency: The patient's final choice follows logically and consistently based on reasoning provided. | Comparative: Patient provides a comparison statement without a statement of specific consequences. Consequential: Patient provides a general statement without details of how the current situation could or could not affect the patient's life. Logical consistency: It is unclear whether the patient's final choice follows logically from the reasoning provided. | Comparative: Patient provides no comparative statements or an illogical comparison. Consequential: Patient provides no everyday consequences or an otherwise illogical answer. Logical consistency: The patient's final choice does not follow logically from the reasoning provided. |
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