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Decision-making around end-of-life care in brain cancer patients: A scoping review - 05/08/22

Doi : 10.1016/j.jemep.2022.100778 
C. Chiang a, 1, S.A. Climans b, f, 1, , K. Edelstein c, d, J.A.H. Bell c, d, e
a School of Medicine, University of St. Andrews Medical School, St Andrews, Scotland 
b Departments of Neurology and Medical Oncology and Hematology, University of Toronto, Toronto, Canada 
c Division of Psychosocial Oncology and Palliative Care, University of Toronto, Toronto, Canada 
d Department of Supportive Care, University of Toronto, Toronto, Canada 
e Princess Margaret Cancer Centre, Dalla Lana School of Public Health, Department of Psychiatry, University of Toronto, Toronto, Canada 
f Department of Oncology, Western University, London, Canada 

Corresponding author at: <Room 18-715, 610 University Ave, Toronto, ON, M5G 2M9, Canada.Canada

Highlights

Some symptom-, disease-, and treatment-specific factors predict incapacity in brain cancer patients.
Standardized tools assessing capacity including the MacCAT-T, CCTI and CCRI, and cognitive batteries can aid capacity assessment.
The prevalence of incapacity in a brain cancer population is 50–61% and this may be an underestimation.
End-of-life choices, including medical assistance in dying, require careful capacity assessment.

Le texte complet de cet article est disponible en PDF.

Summary

Background

Neuro-oncology patients make decisions over their disease course that range in complexity. Clinicians must ensure patients have the decision-making capacity for specific decisions. One decision (in some jurisdictions) is whether to pursue physician-assisted suicide, or medical assistance in dying (MAiD). This is increasingly important as more jurisdictions legalize MAiD. The aim of this scoping review was to explore patient decision-making capacity in neuro-oncology, including measures of capacity and predictors of incapacity for end-of-life decision-making.

Methodology

We conducted two literature searches (“decision making capacity and neuro-oncology” and “MAiD and neuro-oncology”) in five databases.

Objective

We aimed to review the existing literature around capacity assessment in neuro-oncology, the prevalence of incapacity in this patient population, and factors that might predict incapacity. We also aimed to highlight gaps in the literature around MAiD in neuro-oncology.

Results

Standardized tools are available that can supplement clinical capacity assessment. Specific cognitive tests can suggest which domain of capacity is likely to be affected and can guide subsequent intervention. Clinical factors such as tumor grade and various treatments may impact capacity and cognition. In a brain cancer population, the prevalence of incapacity for healthcare decisions is 50-61%. Very little has been published about MAiD in neuro-oncology patients.

Conclusions

There is an established understanding of tools to assess decision-making capacity, but ultimately clinical gestalt is still important. More research is needed to understand whether specific tumor features (e.g., location, size) are implicated in incapacity in general, and specifically in decision-making capacity for end-of-life treatment options, including MAiD.

Le texte complet de cet article est disponible en PDF.

Keywords : Brain metastases, Decisional capacity, End-of-life care, Medical assistance in dying, Primary brain cancer


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Vol 23

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