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

Asao Ogawa, Kyoko Kondo, Hiroyuki Takei, Daisuke Fujisawa, Yuichiro Ohe, Tatsuo Akechi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)489-495
Number of pages7
JournalOncologist
Volume23
Issue number4
DOIs
Publication statusPublished - 2018 Apr

Keywords

  • Cancer
  • Decision-making capacity
  • Frailty
  • Informed consent
  • Supportive care

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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