Ensuring Decisional Capacity

June 16, 2020

Patients with cancer often face difficult, life-changing decisions and encounter clinical situations that may impair or threaten their ability to make those decisions. Determining decisional capacity in patients is often the responsibility of oncologists, but meaningful relationships and familiarity with their patients can sometimes cause the process of assessing cognitive ability and decisional capacity to be overlooked.

Patients with cancer often face difficult, life-changing decisions and encounter clinical situations that may impair or threaten their ability to make those decisions. Determining decisional capacity in patients is often the responsibility of oncologists, but meaningful relationships and familiarity with their patients can sometimes cause the process of assessing cognitive ability and decisional capacity to be overlooked.

In this issue of ONCOLOGY®, Daniel C. McFarland, DO, and colleagues discuss the importance of properly assessing decisional capacity in patients with cancer. “Decisional capacity may fluctuate and requires a variable amount of decisional ability depending on the clinical situation,” writes McFarland. “Hence, it is time-specific and decision-specific.

“Close and deliberate follow-up is a necessary part of managing a patient’s decisional incapacity and capacity,” McFarland continues, when discussing the keys to properly evaluating patients. “Clinicians should resist the temptation to use a single interview…or point in time as a template for future care, since decisional capacity fluctuates and needs to be determined for all decisions where patient engagement and cooperation are appropriate.”

Also in this issue, you will read an article from Christopher R. Flowers, MD, and colleagues from the University of Texas MD Anderson Cancer Center on strategies for overcoming disparities for patients with hematologic malignancies. Flowers and colleagues discuss the differences in incidence, prevalence, and burden of disease in both minority and rural populations compared with the rest of the United States. They propose that among other solutions, improving enrollment in clinical trials can help to alleviate these disparities.

For this month’s clinical quandary, you will read about the case of a 57-year-old man with a diagnosis of stage IVB hypopharynx squamous cell carcinoma. What is the best treatment strategy for larynx preservation? Read on to find out.

Within these pages, you will also find a case study discussing hereditary and familial pancreatic cancers, a roundup of some of the recently released abstracts from the American Urological Association 2020 Virtual Meeting, and a summary of the FDA’s recent approvals of atezolizumab (Tecentriq) and nivolumab (Opdivo) plus ipilimumab (Yervoy), both as frontline therapies for metastatic non–small cell lung cancer. I hope you find our journal helpful in caring for your patients through what is likely one of the most challenging times in their lives. As always, thank you for reading.

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