Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers

Abstract Objective To evaluate the ability of persons with metastatic cancer to self‐assess their medical decision‐making capacity (MDC). To investigate this, we compared an objective measure of MDC with self‐ratings and evaluated predictors of agreement. Methods Data were obtained from a cross‐sect...

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Autores principales:	Mackenzie E. Fowler, Dario A. Marotta, Richard E. Kennedy, Adam Gerstenecker, Meredith Gammon, Kristen Triebel
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	brain metastasis medical decision‐making capacity metastatic cancer predictors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/3a448e66da164c43831ad3380f57fd9a
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spelling	oai:doaj.org-article:3a448e66da164c43831ad3380f57fd9a2021-11-25T06:06:36ZReliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers2162-327910.1002/brb3.2303https://doaj.org/article/3a448e66da164c43831ad3380f57fd9a2021-11-01T00:00:00Zhttps://doi.org/10.1002/brb3.2303https://doaj.org/toc/2162-3279Abstract Objective To evaluate the ability of persons with metastatic cancer to self‐assess their medical decision‐making capacity (MDC). To investigate this, we compared an objective measure of MDC with self‐ratings and evaluated predictors of agreement. Methods Data were obtained from a cross‐sectional study of metastatic cancer patients at a large academic medical center. Across all standards of MDC, sensitivity, specificity, and reliability using Gwet's AC1 statistic were calculated using the objective measure as the gold standard. Logistic regression was used to evaluate predictors of agreement between the measures across all MDC standards. Results In those with brain metastases, high sensitivity (greater than 0.7), but low specificity was observed for all standards. Poor reliability was observed across all standards. Higher age resulted in higher odds of disagreement for Standard 3 (appreciation) (OR: 1.07, 95% CI: 1.00, 1.15) and Standard 4 (reasoning) (OR: 1.05, 95% CI: 1.00, 1.10). For Standard 3, chemotherapy use and brain metastases compared to other metastases resulted in higher odds of disagreement (Chemotherapy: OR: 5.62, 95% CI: 1.37, 23.09, Brain Metastases: OR: 5.93, 95% CI: 1.28, 27.55). For Standard 5 (understanding), no predictors were associated with disagreement. Conclusions For less cognitively complex standards (e.g., appreciation), self‐report may be more valid and reliable than more cognitively complex standards (e.g., reasoning or understanding). However, overall, MDC self‐report in the current sample is suboptimal. Thus, the need for detailed assessment of MDC, especially when patients are older or used chemotherapy, is indicated. Other studies should be conducted to assess MDC agreement longitudinally.Mackenzie E. FowlerDario A. MarottaRichard E. KennedyAdam GersteneckerMeredith GammonKristen TriebelWileyarticlebrain metastasismedical decision‐making capacitymetastatic cancerpredictorsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENBrain and Behavior, Vol 11, Iss 11, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	brain metastasis medical decision‐making capacity metastatic cancer predictors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	brain metastasis medical decision‐making capacity metastatic cancer predictors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Mackenzie E. Fowler Dario A. Marotta Richard E. Kennedy Adam Gerstenecker Meredith Gammon Kristen Triebel Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
description	Abstract Objective To evaluate the ability of persons with metastatic cancer to self‐assess their medical decision‐making capacity (MDC). To investigate this, we compared an objective measure of MDC with self‐ratings and evaluated predictors of agreement. Methods Data were obtained from a cross‐sectional study of metastatic cancer patients at a large academic medical center. Across all standards of MDC, sensitivity, specificity, and reliability using Gwet's AC1 statistic were calculated using the objective measure as the gold standard. Logistic regression was used to evaluate predictors of agreement between the measures across all MDC standards. Results In those with brain metastases, high sensitivity (greater than 0.7), but low specificity was observed for all standards. Poor reliability was observed across all standards. Higher age resulted in higher odds of disagreement for Standard 3 (appreciation) (OR: 1.07, 95% CI: 1.00, 1.15) and Standard 4 (reasoning) (OR: 1.05, 95% CI: 1.00, 1.10). For Standard 3, chemotherapy use and brain metastases compared to other metastases resulted in higher odds of disagreement (Chemotherapy: OR: 5.62, 95% CI: 1.37, 23.09, Brain Metastases: OR: 5.93, 95% CI: 1.28, 27.55). For Standard 5 (understanding), no predictors were associated with disagreement. Conclusions For less cognitively complex standards (e.g., appreciation), self‐report may be more valid and reliable than more cognitively complex standards (e.g., reasoning or understanding). However, overall, MDC self‐report in the current sample is suboptimal. Thus, the need for detailed assessment of MDC, especially when patients are older or used chemotherapy, is indicated. Other studies should be conducted to assess MDC agreement longitudinally.
format	article
author	Mackenzie E. Fowler Dario A. Marotta Richard E. Kennedy Adam Gerstenecker Meredith Gammon Kristen Triebel
author_facet	Mackenzie E. Fowler Dario A. Marotta Richard E. Kennedy Adam Gerstenecker Meredith Gammon Kristen Triebel
author_sort	Mackenzie E. Fowler
title	Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
title_short	Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
title_full	Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
title_fullStr	Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
title_full_unstemmed	Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
title_sort	reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/3a448e66da164c43831ad3380f57fd9a
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Reliability of self‐report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers

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