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Medical decision-making capacity in patients with malignant glioma
Kristen L Triebel1, Roy C Martin, Louis B Nabors
1Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, AL 35294-0017, USA.
Objective:
Patients with malignant glioma (MG) must make ongoing medical treatment decisions concerning a progressive disease that erodes cognition. We prospectively assessed medical decision-making capacity (MDC) in patients with MG using a standardized psychometric instrument.
Methods:
Participants were 22 healthy controls and 26 patients with histologically verified MG. Group performance was compared on the Capacity to Consent to Treatment Instrument (CCTI), a psychometric measure of MDC incorporating 4 standards (choice, understanding, reasoning, and appreciation), and on neuropsychological and demographic variables. Capacity outcomes (capable, marginally capable, or incapable) on the CCTI standards were identified for the MG group. Within the MG group, scores on demographic, clinical, and neuropsychological variables were correlated with scores on each CCTI standard, and significant bivariate correlates were subsequently entered into exploratory stepwise regression analyses to identify multivariate cognitive predictors of the CCTI standards.
Results:
Patients with MG performed significantly below controls on consent standards of understanding and reasoning, and showed a trend on appreciation. Relative to controls, more than 50% of the patients with MG demonstrated capacity compromise (marginally capable or incapable outcomes) in MDC. In the MG group, cognitive measures of verbal acquisition/recall and, to a lesser extent, semantic fluency predicted performance on the appreciation, reasoning, and understanding standards. Karnofsky score was also associated with CCTI performance.
Conclusions:
Soon after diagnosis, patients with malignant glioma (MG) have impaired capacity to make treatment decisions relative to controls. Medical decision-making capacity (MDC) impairment in MG seems to be primarily related to the effects of short-term verbal memory deficits. Ongoing assessment of MDC in patients with MG is strongly recommended.
Insights
Patients with malignant glioma often have impaired medical decision-making capacity (MDC) soon after diagnosis. Cognitive deficits, particularly in verbal memory, contribute to this decline, necessitating ongoing assessment.
Area of Science:
- Neuro-oncology
- Cognitive Neuroscience
- Medical Ethics
Background:
- Malignant glioma (MG) progressively erodes cognitive function, impacting patients' ability to make informed medical treatment decisions.
- Assessing medical decision-making capacity (MDC) is crucial for patients with MG due to the progressive nature of the disease and its cognitive sequelae.
Purpose of the Study:
- To prospectively evaluate medical decision-making capacity (MDC) in patients with malignant glioma (MG) using a standardized psychometric instrument.
- To identify cognitive predictors of impaired MDC in patients with MG.
Main Methods:
- Compared 26 patients with MG and 22 healthy controls on the Capacity to Consent to Treatment Instrument (CCTI), assessing choice, understanding, reasoning, and appreciation.
- Administered neuropsychological tests and collected demographic data.
- Correlated CCTI performance with cognitive and clinical variables in the MG group to identify predictors of MDC.
Main Results:
- Patients with MG showed significantly lower performance than controls on understanding and reasoning standards, with a trend toward lower appreciation.
- Over 50% of MG patients exhibited compromised MDC (marginally capable or incapable).
- Verbal memory and semantic fluency predicted performance on CCTI standards; Karnofsky score also correlated with CCTI performance.
Conclusions:
- Malignant glioma patients demonstrate impaired medical decision-making capacity shortly after diagnosis compared to healthy individuals.
- Short-term verbal memory deficits appear to be the primary cognitive factor contributing to MDC impairment in MG.
- Regular assessment of MDC is strongly recommended for patients diagnosed with malignant glioma.
