Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer.

BACKGROUND The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. MATERIALS AND METHODS We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. RESULTS Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. CONCLUSION A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. IMPLICATIONS FOR PRACTICE Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients.

[1]  G. Cutter,et al.  Capacity of patients with brain metastases to make treatment decisions , 2015, Psycho-oncology.

[2]  P. Lepping,et al.  Systematic review on the prevalence of lack of capacity in medical and psychiatric settings. , 2015, Clinical medicine.

[3]  Janeane L. Walker,et al.  Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. , 2014, The lancet. Psychiatry.

[4]  J. Jackson,et al.  Does this patient have medical decision-making capacity? , 2011, JAMA.

[5]  J. Temel,et al.  Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  M. Bruce,et al.  Depression and barriers to mental health care in older cancer patients , 2011, International journal of geriatric psychiatry.

[7]  S. Pal,et al.  Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment , 2010, CA: a cancer journal for clinicians.

[8]  Robert Pirker,et al.  Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial , 2009, The Lancet.

[9]  M. Adachi,et al.  Patient willingness to undergo chemotherapy and thoracic radiotherapy for locally advanced non‐small cell lung cancer , 2009, Psycho-oncology.

[10]  Seth Wolpin,et al.  Depression screening using the Patient Health Questionnaire‐9 administered on a touch screen computer , 2009, Psycho-oncology.

[11]  Jayne Tierney,et al.  Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: a systematic review and meta-analysis of individual patient data from 16 randomized controlled trials. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  B. Xie,et al.  Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  A. Bezjak,et al.  Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  M. Elliott,et al.  Higher Vulnerable Elders Survey Scores Predict Death and Functional Decline in Vulnerable Older People , 2006, Journal of the American Geriatrics Society.

[15]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[16]  M. Hotopf,et al.  Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study , 2004, The Lancet.

[17]  P. Shekelle,et al.  The Vulnerable Elders Survey: A Tool for Identifying Vulnerable Older People in the Community , 2001, Journal of the American Geriatrics Society.

[18]  D. Royall,et al.  The FAB: A frontal assessment battery at bedside , 2001, Neurology.

[19]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[20]  D Hamerman,et al.  Toward an Understanding of Frailty , 1999, Annals of Internal Medicine.

[21]  D. Tucker Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals , 1998 .

[22]  H. Welch,et al.  Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews , 1998, BMJ.

[23]  P. Appelbaum,et al.  The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. , 1997, Psychiatric services.

[24]  L. Harrell,et al.  Assessing the competency of patients with Alzheimer's disease under different legal standards. A prototype instrument. , 1995, Archives of neurology.

[25]  L. Påhlman,et al.  Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer , 1994, Cancer.

[26]  T. Grisso Evaluating Competencies: Forensic Assessments and Instruments , 1986 .

[27]  A. Elwork,et al.  Competence to consent to treatment as a psycholegal construct , 1984, Law and human behavior.

[28]  S. Folstein,et al.  “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician , 1975 .

[29]  Ninoslav Mimica,et al.  Dementia: a public health priority , 2019 .

[30]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[31]  M. Brundage,et al.  Trading treatment toxicity for survival in locally advanced non-small cell lung cancer. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[32]  T. Travis Informed Consent: Legal Theory and Clinical Practice , 1990 .