title: Impairment of medical decisional capacity in relation to Karnofsky Performance Status in adults with malignant brain tumor.
abstract: BACKGROUND
  We aimed to investigate the relationship between medical decisional capacity (MDC) and Karnofsky Performance Status (KPS) in adults with malignant brain tumors.
  
  
  METHODS
  Participants were 71 adults with primary (n= 26) or metastatic (n= 45) brain tumors. Testing to determine KPS scores and MDC was performed as close together as possible for each patient. Participants were administered a standardized measure of medical decision-making capacity (Capacity to Consent to Treatment Instrument [CCTI]) to assess 3 treatment consent abilities (ie,appreciation, reasoning,andunderstanding). Capacity classifications (ie, capable, marginally capable, and incapable) were established using cut scores previously derived from healthy control CCTI performance.
  
  
  RESULTS
  The majority of participants had KPS scores of 90-100 (n= 39), with the remainder divided between KPS scores of 70-80 (n= 26) and 50-60 (n= 6). Comparisons between persons with KPS scores of 90-100 or 70-80 revealed significant differences on the CCTI consent standards ofunderstandingandappreciation.Participants with KPS ratings of 90-100 achieved 46% capable classifications across all CCTI standards, in contrast with 23% of participants with KPS ratings of 70-80, and 0% of participants with KPS ratings of 50-60.
  
  
  CONCLUSIONS
  A substantial portion of brain-tumor patients with KPS scores reflecting only minimal disability nonetheless demonstrated impairments on standardized measures of MDC. Clinicians working with this adult population should carefully screen for capacity to make clinical treatment decisions regardless of functional/performance status.
authors.affiliation: Department of Neurology , Division of Neuropsychology, University of Alabama at Birmingham , Birmingham, Alabama (R.C.M., A.G., D.C.M., K.L.T.); Comprehensive Cancer Center, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.); Department of Neurology , Division of Neuro-Oncology, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.).
authors.forename: Roy C
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Department of Neurology , Division of Neuropsychology, University of Alabama at Birmingham , Birmingham, Alabama (R.C.M., A.G., D.C.M., K.L.T.); Comprehensive Cancer Center, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.); Department of Neurology , Division of Neuro-Oncology, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.).
authors.forename: Adam
authors.initials: A
authors.lastname: Gerstenecker
authors.affiliation: Department of Neurology , Division of Neuropsychology, University of Alabama at Birmingham , Birmingham, Alabama (R.C.M., A.G., D.C.M., K.L.T.); Comprehensive Cancer Center, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.); Department of Neurology , Division of Neuro-Oncology, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.).
authors.forename: Louis B
authors.initials: LB
authors.lastname: Nabors
authors.affiliation: Department of Neurology , Division of Neuropsychology, University of Alabama at Birmingham , Birmingham, Alabama (R.C.M., A.G., D.C.M., K.L.T.); Comprehensive Cancer Center, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.); Department of Neurology , Division of Neuro-Oncology, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.).
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Marson
authors.affiliation: Department of Neurology , Division of Neuropsychology, University of Alabama at Birmingham , Birmingham, Alabama (R.C.M., A.G., D.C.M., K.L.T.); Comprehensive Cancer Center, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.); Department of Neurology , Division of Neuro-Oncology, University of Alabama at Birmingham , Birmingham, Alabama (L.B.N.).
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Triebel
keywords: cerebral neoplasm; cognitive function; medical decision-making; medical ethics; treatment consent