Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine

A.V. Louie; E. Chan; M. Hanna; G.S. Bauman; B.J. Fisher; D.A. Palma; G.B. Rodrigues; A. Warner; D.P. D'Souza

doi:10.3747/co.20.1260

Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine

Current Oncology ◽

10.3747/co.20.1260 ◽

2013 ◽

Vol 20 (2) ◽

Cited By ~ 5

Author(s):

A.V. Louie ◽

E. Chan ◽

M. Hanna ◽

G.S. Bauman ◽

B.J. Fisher ◽

...

Keyword(s):

Brain Tumour ◽

Grey Matter ◽

Fitness To Drive

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Multidisciplinary assessment of fitness to drive in brain tumour patients in southwestern Ontario: a grey matter

Current Oncology ◽

10.3747/co.20.1198 ◽

2013 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

E. Chan ◽

A.V. Louie ◽

M. Hanna ◽

G.S. Bauman ◽

B.J. Fisher ◽

...

Keyword(s):

Brain Tumour ◽

Grey Matter ◽

Fitness To Drive ◽

Multidisciplinary Assessment

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Multidisciplinary assessment and reporting of fitness to drive in brain tumor patients: A gray matter.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6130 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6130-6130

Author(s):

Alexander V. Louie ◽

Esther Chan ◽

Michelle Hanna ◽

David Palma ◽

Glenn Bauman ◽

...

Keyword(s):

Logistic Regression ◽

Brain Tumour ◽

Mail Survey ◽

Family Physicians ◽

Fitness To Drive ◽

Exact Test ◽

Physician Knowledge ◽

Brain Radiotherapy ◽

Factors Influencing ◽

The Impact

6130 Background: In some jurisdictions, there is a legal requirement for physicians to report medically unfit drivers. Objectives of this study are to determine physician knowledge and attitudes on reporting legislation and driving assessment, and review our institution’s experience in evaluating fitness to drive in brain tumour patients. Methods: Physicians caring for brain tumour patients in South-western Ontario were identified by public databases and surveyed by mail. Survey questions elicited demographics, opinions, and factors influencing the decision to report. Patients receiving brain radiotherapy at our institution between January and June 2009 were identified and details of driving assessment were extracted. Fisher’s exact test and a logistic regression model were used to determine differences in responses between specialists and family physicians and factors influencing reporting. Results: Surveys (n=467) were distributed with 198 (43%) responses. Most (76%) felt that reporting guidelines were unclear. Neurologists (43%) and Family Physicians (22%) were felt to be the most responsible to report unfit drivers. Compared to specialists, Family Physicians were less likely: to be comfortable with reporting (p=0.02), to consider reporting (p<0.001), or discuss the implications of driving (p<0.001). Perceived barriers in assessing fitness to drive included: lack of tools to assess (57%) and the impact on the patient-physician relationship (34%). 158 patients were retrospectively reviewed. Forty-eight patients (30%) were reported to the provincial licensing authority and 64 (41%) were advised not to drive. 53 patients experienced seizures, of which 36 (68%) had a documented discussion on driving. Only 30 (56%) of these patients were reported to the licensing authority despite legal requirements. Age, primary disease, previous neurosurgery and seizures were predictive of reporting (p<0.05). On logistic regression modeling, seizures (OR 12.4) and primary CNS disease (OR 15.5) remained predictive of reporting. Conclusions: Despite guidelines and laws, the assessment of fitness to drive in patients with brain tumours is not routinely conducted or documented in a multidisciplinary setting.

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