Patients with terminal cancer face difficult decisions. What treatment options support their goals? When is it reasonable to discontinue care? A study published in the American Journal of Geriatric Psychiatry shows that these patients may be less competent to make these decisions than their doctors think.
Patients with terminal cancer face difficult decisions. What treatment options support their goals? When is it reasonable to discontinue care? A study published in the American Journal of Geriatric Psychiatry shows that these patients may be less competent to make these decisions than their doctors think.
“Early in my graduate career, I did a lot of interviews with patients exploring their wishes for end-of-life care. But you end up talking about other things as well. I found patients who didn’t know why they were in the hospital or had forgotten or weren’t aware their cancer was so advanced. And I recognized these patients were still responsible for making big decisions. This study grew out of that experience,” says Elissa Kolva, PhD, investigator at the University of Colorado Cancer Center and assistant professor at the CU School of Medicine Division of Medical Oncology.
Kolva’s study used a psychological assessment tool called the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. She then compared scores of 55 advanced cancer patients with scores of 50 healthy adults. The MacCAT-T, which has been used in studies of Alzheimer’s, Parkinson’s and cognitive impairment, presents a hypothetical medical situation including treatment options and then asks participants to reason through their choice.
In all, 85.7 percent of patients with advanced cancer were able to express a treatment choice (compared with 100 percent of healthy adults). Forty-four percent of patients but only eight percent of healthy adults showed impaired understanding; Forty-nine percent of patients and eight percent of healthy adults showed impaired appreciation; and 85.4 percent of patients versus 10 percent of healthy adults showed impaired reasoning.
Read more at University of Colorado Anschutz Medical Campus
Image: Elissa Kolva, PhD, and colleagues show a mismatch between measurement of patients' decision-making capacity and doctors' opinions of capacity. (Credit: University of Colorado Cancer Center)
