Cancer Res Treat.  2018 Jul;50(3):681-690. 10.4143/crt.2017.201.

Patient's Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis

Affiliations
  • 1Supportive Care Center, Samsung Comprehensive Cancer Center, Seoul, Korea.
  • 2Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Cancer Education Center, Samsung Comprehensive Cancer Center, School of Medicine and SAHIST, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • 5Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • 6Cancer Policy Branch, National Cancer Center, Goyang, Korea. jonghyock@gmail.com park.keeho@gmail.com
  • 7Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 8College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea.
  • 9Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 10Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.
  • 11Department of Preventive Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea.

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 andwere asked to express their preferences forfamily 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 makingwith 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 κ=0.32, κ=0.26, and κ=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.

Keyword

Neoplasms; Family involvement; Cognitive function; Treatment decision; Caregivers
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