TY - JOUR
T1 - Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer
AU - Ogawa, Asao
AU - Kondo, Kyoko
AU - Takei, Hiroyuki
AU - Fujisawa, Daisuke
AU - Ohe, Yuichiro
AU - Akechi, Tatsuo
N1 - Funding Information:
We thank Kiyoko Otani, Miwa Ito, Ado Tange, Kyoko Hayashi, Aya Makino, and Akihiro Nitto for their assistance in conducting this study. This work was supported by a Grant-in-aid for Cancer Research from the Japanese Ministry of Labor, Health, and Welfare.
Publisher Copyright:
© AlphaMed Press 2017
PY - 2018/4
Y1 - 2018/4
N2 - 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.
AB - 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.
KW - Cancer
KW - Decision-making capacity
KW - Frailty
KW - Informed consent
KW - Supportive care
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U2 - 10.1634/theoncologist.2017-0187
DO - 10.1634/theoncologist.2017-0187
M3 - Article
C2 - 29212735
AN - SCOPUS:85045841283
SN - 1083-7159
VL - 23
SP - 489
EP - 495
JO - Oncologist
JF - Oncologist
IS - 4
ER -