Impact of Medical Hospitalization on Treatment Decision-Making Capacity in the Elderly

1990 ◽  
Vol 150 (8) ◽  
pp. 1717 ◽  
Author(s):  
L. Jaime Fitten
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
The Elderly ◽  
Treatment Decision Making ◽  
Decision Making Capacity

scholarly journals Infused Chemotherapy Use in the Elderly After Patent Expiration

2012 ◽  
Vol 8 (3S) ◽  
pp. e18s-e23s ◽  
Author(s):  
Rena M. Conti ◽  
Meredith B. Rosenthal ◽  
Blase N. Polite ◽  
Peter B. Bach ◽  
Ya-Chen Tina Shih
Keyword(s):  
Decision Making ◽  
Cost Efficiency ◽  
Empirical Work ◽  
Treatment Decision ◽  
The Elderly ◽  
Patent Expiration ◽  
Treatment Decision Making

As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types.

‘Mental disorder’ and public protection

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Mental Disorder ◽  
Treatment Decision ◽  
Persons With Disabilities ◽  
The Public ◽  
Treatment Decision Making ◽  
Decision Making Capacity ◽  
United Nations Convention ◽  
Current Systems

The implications of a Fusion Law for the management and treatment of people with impairments or disturbances in the functioning of mind who have committed offences is examined in this chapter. Concerns about public protection under a Fusion Law have been raised, particularly in relation to serious offences. Fusion Law principles can be applied with fair procedures regarding sentencing and hospitalization for those with a mental illness. The public can be protected on the same basis as for those without a mental illness. Options for extended sentences exist in many countries, equally applicable to all persons. ‘Unfitness to plead’ and ‘not guilty by reason of insanity’ present, under current systems, a problem when a person now has treatment decision-making capacity but is deemed a risk. The implications of the Fusion Law for the treatment of ‘psychopathy’ and the addictions are examined. The United Nations Convention on the Rights of Persons with Disabilities poses dilemmas for which solutions are uncertain.

scholarly journals Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis

2017 ◽  
Vol 211 (4) ◽  
pp. 205-215 ◽  
Author(s):  
Amanda Larkin ◽  
Paul Hutton
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Treatment Decision ◽  
Psychotic Symptoms ◽  
Related Factors ◽  
Treatment Decision Making ◽  
Effective Strategies ◽  
Decision Making Capacity

BackgroundThe evidence on factors that may influence treatment decisional capacity (‘capacity’) in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it.AimsTo determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment-related factors, thus providing a thorough synthesis of current knowledge.MethodWe conducted a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis, assessing the direction, magnitude, significance and reliability of reported associations.ResultsWe identified 23 relevant studies (n= 1823). Psychotic symptoms had small, moderate and strong associations with appreciation, understanding and reasoning respectively. Both verbal cognitive functioning and duration of education had small to moderate correlations with understanding and reasoning. Better capacity was also associated with better insight, better metacognitive ability, higher anxiety and lower perceived coercion. No linear relationship with depression was observed. Interventions linked to improved capacity over time were in-patient care, information simplification, shared decision-making and metacognitive training.ConclusionsAlthough much is known about the role of symptoms and other clinical variables, effective and acceptable psychological interventions to support capacity in this group are lacking.

scholarly journals Tumor Treating Fields for Glioblastoma Therapy During the COVID-19 Pandemic

2021 ◽  
Vol 11 ◽  
Author(s):  
Na Tosha N. Gatson ◽  
Jill Barnholtz-Sloan ◽  
Jan Drappatz ◽  
Roger Henriksson ◽  
Andreas F. Hottinger ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
Health Care Systems ◽  
Panel Discussion ◽  
Treatment Decision ◽  
The Elderly ◽  
Tumor Patients ◽  
Treatment Decision Making ◽  
Tumor Treating Fields ◽  
Care Systems

BackgroundThe COVID-19 pandemic has placed excessive strain on health care systems and is especially evident in treatment decision-making for cancer patients. Glioblastoma (GBM) patients are among the most vulnerable due to increased incidence in the elderly and the short survival time. A virtual meeting was convened on May 9, 2020 with a panel of neuro-oncology experts with experience using Tumor Treating Fields (TTFields). The objective was to assess the risk-to-benefit ratio and provide guidance for using TTFields in GBM during the COVID-19 pandemic.Panel DiscussionTopics discussed included support and delivery of TTFields during the COVID-19 pandemic, concomitant use of TTFields with chemotherapy, and any potential impact of TTFields on the immune system in an intrinsically immunosuppressed GBM population. Special consideration was given to TTFields' use in elderly patients and in combination with radiotherapy regimens. Finally, the panel discussed the need to better capture data on COVID-19–positive brain tumor patients to analyze longitudinal outcomes and changes in treatment decision-making during the pandemic.Expert OpinionTTFields is a portable home-use device which can be managed via telemedicine and safely used in GBM patients during the COVID-19 pandemic. TTFields has no known immunosuppressive effects which is important during a crisis where other treatment methods might be limited, especially for elderly patients with multiple co-morbidities. It is too early to estimate the full impact of COVID-19 on the global healthcare system and on patient outcomes and the panel strongly recommended collaboration with existing cancer COVID-19 registries to follow CNS tumor patients.

Screening and Treating Prostate Cancer in the Older Patient: Decision Making Across the Clinical Spectrum

2017 ◽  
pp. 370-381
Author(s):  
Alicia K. Morgans ◽  
William Dale ◽  
Alberto Briganti
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Elderly Population ◽  
Prostate Cancer Screening ◽  
Treatment Decision ◽  
The Elderly ◽  
Developed Countries ◽  
Elderly Men ◽  
Geriatric Population ◽  
Treatment Decision Making

Treatment of the growing geriatric patient population is increasingly being recognized as a necessary priority of the oncology community. As the most common cancer among men in developed countries, prostate cancer afflicts a sizable portion of elderly men. Caring for this population requires knowledge of aspects of disease presentation, screening strategies, treatment approaches, and survivorship care considerations unique to the geriatric population. In this article, we review characteristics of prostate cancer screening and treatment decision making for localized disease in elderly men, including a discussion of the biology of disease in the elderly population. We also review best practices for providing treatment for localized and recurrent disease in an elderly population, including engaging in a basic geriatric assessment to determine fitness for treatment, eliciting information about patient preferences and support systems, and balancing treatment decisions in the context of these factors using the resources of a multidisciplinary care team. We then consider complications of prostate cancer survivorship related to systemic treatment in the elderly population of men with this disease. Finally, we emphasize the importance of engaging patients in treatment decision making across the spectrum of disease to personalize treatment plans and provide optimal care.

scholarly journals Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

2017 ◽  
Vol 27 (5) ◽  
pp. 492-499 ◽  
Author(s):  
G. Mandarelli ◽  
F. Carabellese ◽  
G. Parmigiani ◽  
F. Bernardini ◽  
L. Pauselli ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Functioning ◽  
Rating Scale ◽  
Psychiatric Treatment ◽  
Treatment Decision ◽  
Mental Capacity ◽  
Treatment Decision Making ◽  
Decision Making Capacity ◽  
Hospitalised Patients ◽  
High Treatment

Aims.To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients.Methods.131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed.Results.Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p< 0.05) and reasoning (p< 0.01). Positive symptoms were associated with poorer capacity to appreciate (r= −0.24;p< 0.01) and reason (r= −0.27;p< 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r= −0.23;p< 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSDr= 0.37;p< 0.01; BDr= −0.01;p= 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BDr= −0.32;p< 0.05; SSDr= 0.03;p= 0.8). Twenty-two per cent (n= 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% ofunderstanding, appreciating and reasoningMacCAT-T subscales maximum sores and 2 atexpressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p< 0.001).Conclusions.Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.

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