Patient’s Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis
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Purpose Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. Materials and Methods A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea and were asked to express their preferences for family involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). Results Both patients and family caregivers preferred greater family dominance in treatment decision making with the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted =0.32, =0.26, and =0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. Conclusion Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.
Abstract
Purpose Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. Materials and Methods A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea and were asked to express their preferences for family involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). Results Both patients and family caregivers preferred greater family dominance in treatment decision making with the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted =0.32, =0.26, and =0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. Conclusion Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.
참고문헌 (30)
- Hamann J, "Patient participation in medical and social decisions in Alzheimer's disease", J Am Geriatr Soc, 59, pp.2045~2052 (2011)[DOI]
- Sharma RK, "Family understanding of seriously-ill patient preferences for family involvement in healthcare decision making", J Gen Intern Med, 26, pp.881~886 (2011)[DOI]
- Nolan MT, "When patients lack capacity: the roles that patients with terminal diagnoses would choose for their physicians and loved ones in making medical decisions", J Pain Symptom Manage, 30, pp.342~353 (2005)[DOI]
- Caillet P, "Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study", J Clin Oncol, 29, pp.3636~3642 (2011)[DOI]
- Molina-Garrido MJ, "Development of a cancer-specific comprehensive geriatric assessment in a university hospital in Spain", Crit Rev Oncol Hematol, 77, pp.148~161 (2011)[DOI]
- Grosshans DR, "Neurocognitive function in patients with small cell lung cancer: effect of prophylactic cranial irradiation", Cancer, 112, pp.589~595 (2008)[DOI]
- Schagen SB, "Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer", Acta Oncol, 47, pp.63~70 (2008)[DOI]
- Chen X, "Dissociation of decision making under ambiguity and decision making under risk in breast cancer patients receiving adjuvant chemotherapy: a neuropsychological study", Brain Res, 1533, pp.63~72 (2013)[DOI]
- Shin DW, "Preferences for and experiences of family involvement in cancer treatment decision-making: patient-caregiver dyads study", Psychooncology, 22, pp.2624~2631 (2013)[DOI]
- Shin DW, "Attitudes toward family involvement in cancer treatment decision making: the perspectives of patients, family caregivers, and their oncologists", Psychooncology, 26, pp.770~778 (2017)[DOI]
- Degner LF, "The Control Preferences Scale", Can J Nurs Res, 29, pp.21~43 (1997)
- Makoul G, "An integrative model of shared decision making in medical encounters", Patient Educ Couns, 60, pp.301~312 (2006)[DOI]
- Harzing AW, "Response style differences in cross-national research", Manag Int Rev, 52, pp.341~363 (2012)[DOI]
- Wolfs CA, "Rational decision-making about treatment and care in dementia: a contradiction in terms?", Patient Educ Couns, 87, pp.43~48 (2012)[DOI]
- Hirschman KB, "How does an Alzheimer's disease patient's role in medical decision making change over time?", J Geriatr Psychiatry Neurol, 17, pp.55~60 (2004)[DOI]
- Miller LM, "Shared decision-making in dementia: a review of patient and family carer involvement", Dementia (London), 15, pp.1141~1157 (2016)[DOI]
- Ishikawa H, "Patients' perceptions of visit companions' helpfulness during Japanese geriatric medical visits", Patient Educ Couns, 61, pp.80~86 (2006)[DOI]
- Hirschman KB, "Would caregivers of Alzheimer disease patients involve their relative in a decision to use an AD-slowing medication?", Am J Geriatr Psychiatry, 13, pp.1014~1021 (2005)[DOI]
- Karel MJ, "Three methods of assessing values for advance care planning: comparing persons with and without dementia", J Aging Health, 19, pp.123~151 (2007)[DOI]
- Karlawish JH, "Relationship between Alzheimer's disease severity and patient participation in decisions about their medical care", J Geriatr Psychiatry Neurol, 15, pp.68~72 (2002)[DOI]
- Samsi K, "Everyday decision-making in dementia: findings from a longitudinal interview study of people with dementia and family carers", Int Psychogeriatr, 25, pp.949~961 (2013)[DOI]
- Feinberg LF, "Are persons with cognitive impairment able to state consistent choices?", Gerontologist, 41, pp.374~382 (2001)[DOI]
- de Boer ME, "Thoughts on the future: the perspectives of elderly people with early-stage Alzheimer's disease and the implications for advance care planning", AJOB Prim Res, 3, pp.14~22 (2012)[DOI]
- MacQuarrie CR, "Experiences in early stage Alzheimer's disease: understanding the paradox of acceptance and denial", Aging Ment Health, 9, pp.430~441 (2005)[DOI]
- Hirschman KB, "Do Alzheimer's disease patients want to participate in a treatment decision, and would their caregivers let them?", Gerontologist, 45, pp.381~388 (2005)[DOI]
- Grisso T, "The MacArthur Treatment Competence Study. III: Abilities of patients to consent to psychiatric and medical treatments", Law Hum Behav, 19, pp.149~174 (1995)[DOI]
- Hilgeman MM, "Preserving Identity and Planning for Advance Care (PIPAC): preliminary outcomes from a patient-centered intervention for individuals with mild dementia", Aging Ment Health, 18, pp.411~424 (2014)[DOI]
- Murphy J, "The use of Talking Mats to support people with dementia and their carers to make decisions together", Health Soc Care Community, 21, pp.171~180 (2013)[DOI]
- Whitlatch CJ, "Dyadic intervention for family caregivers and care receivers in early-stage dementia", Gerontologist, 46, pp.688~694 (2006)[DOI]
- Tariman JD, "Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review", Ann Oncol, 21, pp.1145~1151 (2010)[DOI]