Assessing medical decision making capacity among cancer patients: Preliminary clinical experience of using a competency assessment instrument

2013 ◽  
Vol 13 (6) ◽  
pp. 1529-1533 ◽  
Author(s):  
Tatsuo Akechi ◽  
Toru Okuyama ◽  
Megumi Uchida ◽  
Koji Sugano ◽  
Yosuke Kubota ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Past History ◽  
Structured Interview ◽  
Assessment Instrument ◽  
Medical Decision ◽  
Dementia Patient ◽  
Decision Making Capacity

AbstractObject:This study investigates the usefulness of the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory (SICIATRI) for cancer patients, which is a structured interview that assesses a patient's competency in clinical practice.Methods:The SICIATRI, originally developed to measure patients' competency to give informed consent, were administered referred cancer patients who needed for assessing medical decision making capacity. The usefulness of the SICIATRI was investigated retrospectively. Recommendation for modification of the SICIATRI for cancer patients if applicable were made by the research team.Results:Among the 433 cancer patients referred for psychiatric consultation, 12 were administered the SICIATRI and all of the administration were conducted without big problems. All patients were 60 years or older. The most common purpose for competency evaluation was to analyze patients' understanding of the anti-cancer treatment proposed by oncologists, followed by their refusal of the treatment. Half of the patients (n = 6) were diagnosed with delirium and three among them were judged as having the most impaired status of a patient's competency. Two patients (17%) were diagnosed with major depression and another two (17%) were mental retardation and each one patient was diagnosed with dementia and past history of alcohol dependence. Among 6 patients without delirium 5 subjects including a dementia patient were judged as fully competent. Total of 5 small potential modifications of the SICIATRI for its use with Japanese cancer patients were recommended.Significance of results:Our experience suggests that the SICIATRI is a useful instrument for psycho-oncology clinical practice.

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

2021 ◽  
pp. 147775092110698
Author(s):  
Alexia Zagouras ◽  
Elise Ellick ◽  
Mark Aulisio
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Medical Decision Making ◽  
Life Experience ◽  
Pregnant Patient ◽  
Medical Decision ◽  
Individual Autonomy ◽  
Caregiver Support ◽  
Neurological Condition ◽  
Decision Making Capacity

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

The Contextual Nature of Critical Care Judgment

1994 ◽  
Vol 9 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Gilbert M. Goldman ◽  
Thyyar M. Ravindranath
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Judgment ◽  
Retrospective Review ◽  
Medical Decision Making ◽  
Formal Analysis ◽  
Medical Decision ◽  
Time Constraints ◽  
Care Decision

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

scholarly journals The Effects of Brain Tumours upon Medical Decision-Making Capacity

2019 ◽  
Vol 21 (6) ◽  
Author(s):  
Will Hewins ◽  
Karolis Zienius ◽  
James L. Rogers ◽  
Simon Kerrigan ◽  
Mark Bernstein ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Tumours ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Capacity

Limits of trust in medical AI

2020 ◽  
Vol 46 (7) ◽  
pp. 478-481 ◽  
Author(s):  
Joshua James Hatherley
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Diabetic Retinopathy ◽  
Deep Learning ◽  
Clinical Practice ◽  
Medical Decision Making ◽  
Hospital Readmissions ◽  
New Drugs ◽  
Medical Decision ◽  
Practice Of Medicine

Artificial intelligence (AI) is expected to revolutionise the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI’s progress in medicine, however, has led to concerns regarding the potential effects of this technology on relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, since AI systems can be relied on, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely on AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice.

scholarly journals Considerations of healthcare professionals in medical decision-making about treatment for clinical end-stage cancer patients

2004 ◽  
Vol 28 (4) ◽  
pp. 351-355 ◽  
Author(s):  
Anna F. van Leeuwen ◽  
Elsbeth Voogt ◽  
Adriaan Visser ◽  
Carin C.D. van der Rijt ◽  
Agnes van der Heide
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Healthcare Professionals ◽  
Medical Decision ◽  
End Stage
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