Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T09:17:04.920Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 October 2013

Tatsuo Akechi ,
Toru Okuyama ,
Megumi Uchida ,
Koji Sugano ,
Yosuke Kubota ,
Yoshinori Ito ,
Nobuhiro Sakamoto  and
Yoshiyuki Kizawa
Tatsuo Akechi*
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital
Toru Okuyama
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital
Megumi Uchida
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital
Koji Sugano
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences Division of Respiratory Medicine, Juntendo University Faculty of Medicine & Graduate School of Medicine
Yosuke Kubota
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences
Yoshinori Ito
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital
Nobuhiro Sakamoto
Affiliation:
Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences OR
Yoshiyuki Kizawa
Affiliation:
Division of Palliative Medicine, Department of Internal Related Kobe University Graduate School of Medicine
*
Address correspondence and reprint requests to: Tatsuo Akechi, Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601Japan. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Object:

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.

Keywords

CancerDecision makingInformed consentPsychiatric co-morbidity
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1529 - 1533
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akechi, T., Nakano, T., Akizuki, N., et al. (2003). Psychiatric evaluation of competency in cancer patients. International Journal of Psychiatry in Clinical Practice, 7, 101–106.Google Scholar
Akechi, T., Miyashita, M., Morita, T., et al. (2012). Good death in elderly adults with cancer in Japan based on perspectives of the general population. J Am Geriatr Soc, 60, 271–276.Google Scholar
Appelbaum, P.S. (2007). Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med, 357, 1834–1840.Google Scholar
Clark, J.A., Wray, N.P., Ashton, CM. (2001). Living with treatment decisions: regrets and quality of life among men treated for metastatic prostate cancer. J Clin Oncol, 19, 72–80.CrossRefGoogle ScholarPubMed
Derogatis, L.R., Morrow, G.R., Fetting, J., et al. (1983). The prevalence of psychiatric disorders among cancer patients. Jama, 249, 751–757.Google Scholar
Kitamura, T., Kitamura, F. (2012). Competency assessment in clinical and research settings: theory and practice. Japanese Journal of Clinical Psychopharmacology, 15, 1751–1757.Google Scholar
Knowles, F.E. 3rd, Liberto, J., Baker, F.M., et al. (1994). Competency evaluations in a VA hospital. A 10-year perspective. Gen Hosp Psychiatry, 16, 119–124.Google Scholar
Lawlor, P.G., Gagnon, B., Mancini, I.L., et al. (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med, 160, 786–794.Google Scholar
Lepping, P. (2011). Overestimating patients' capacity. Br J Psychiatry, 199, 355–356.Google Scholar
Minagawa, H., Uchitomi, Y., Yamawaki, S., et al. (1996). Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer, 78, 1131–1137.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Ruhnke, G.W., Wilson, S.R., Akamatsu, T., et al. (2000). Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest, 118, 1172–1182.Google Scholar
Sessums, L.L., Zembrzuska, H., Jackson, J.L. (2011). Does this patient have medical decision-making capacity? JAMA, 306, 420–427.Google Scholar
Tamburini, M., Buccheri, G., Brunelli, C., et al. (2000). The difficult choice of chemotherapy in patients with unresectable non-small-cell lung cancer. Support Care Cancer, 8, 223–228.Google Scholar
Tomoda, A., Yasumiya, R., Sumiyama, T., et al. (1997). Validity and reliability of Structured Interview for Competency Incompetency Assessment Testing and Ranking Inventory. J Clin Psychol, 53, 443–450.Google Scholar