title: Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians.
abstract: BACKGROUND
  Decision-making capacity to provide informed consent regarding treatment is essential among cancer patients. The purpose of this study was to identify the frequency of decision-making incapacity among newly diagnosed older patients with hematological malignancy receiving first-line chemotherapy, to examine factors associated with incapacity and assess physicians' perceptions of patients' decision-making incapacity.
  
  
  METHODS
  Consecutive patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Decision-making capacity was assessed using the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory-Revised (SICIATRI-R). Cognitive impairment, depressive condition and other possible associated factors were also evaluated.
  
  
  RESULTS
  Among 139 eligible patients registered for this study, 114 completed the survey. Of these, 28 (25%, 95% confidence interval [CI]: 17%-32%) were judged as having some extent of decision-making incompetency according to SICIATRI-R. Higher levels of cognitive impairment and increasing age were significantly associated with decision-making incapacity. Physicians experienced difficulty performing competency assessment (Cohen's kappa -0.54).
  
  
  CONCLUSIONS
  Decision-making incapacity was found to be a common and under-recognized problem in older patients with cancer. Age and assessment of cognitive impairment may provide the opportunity to find patients that are at a high risk of showing decision-making incapacity.
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan; Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
authors: Koji
authors: K
authors: Sugano
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan.
authors: Toru
authors: T
authors: Okuyama
authors: Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Shinsuke
authors: S
authors: Iida
authors: Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Hirokazu
authors: H
authors: Komatsu
authors: Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Takashi
authors: T
authors: Ishida
authors: Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Shigeru
authors: S
authors: Kusumoto
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan.
authors: Megumi
authors: M
authors: Uchida
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan.
authors: Tomohiro
authors: T
authors: Nakaguchi
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Yosuke
authors: Y
authors: Kubota
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan.
authors: Yoshinori
authors: Y
authors: Ito
authors: Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
authors: Kazuhisa
authors: K
authors: Takahashi
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan.
authors: Tatsuo
authors: T
authors: Akechi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology; D008223:Lymphoma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D009101:Multiple Myeloma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents