Medical Decision-Making in Oncology for Patients Lacking Capacity.
Medical Decision-Making in Oncology for Patients Lacking Capacity.
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DOI：
10.1200/edbk_280279
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发表时间：
2020-03
期刊：
影响因子：
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通讯作者：
Magnuson A
中科院分区：
文献类型：
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作者：
Marron JM;Kyi K;Appelbaum PS;Magnuson A
现代肿瘤学实践是建立在这样一种理念之上的，即癌症患者有法律的和道德的权利来决定他们的医疗护理。然而，在某些情况下，患者可能不再完全能够代表自己做出决定，有些患者永远无法这样做。在这种情况下，关键是要知道如何确定患者是否有能力做出医疗决定，如果他们没有，应该做什么。在这里，我们研究了肿瘤学中决策能力的概念，并探讨了患者可能改变/降低能力的情况（例如，抑郁症、认知障碍、谵妄、脑肿瘤、脑转移等）或从未有过决策能力（例如，未成年人、发育残疾的成年人）。我们描述了在照顾缺乏决策能力的癌症患者时要考虑的基本原则。然后，我们介绍了能力评估的策略，以及临床医生如何在患者缺乏能力对癌症护理做出决定的情况下进行导航。最后，我们探讨了儿科和内科肿瘤学在这些具有挑战性的情况下可以相互学习的方法。患有癌症的患者有时缺乏对其医疗护理做出决定的能力。如何最好地驾驭这些复杂的，有压力的案件？
Modern oncology practice is built upon the idea that a patient with cancer has the legal and ethical right to make decisions about their medical care. There are situations in which patients might no longer be fully able to make decisions on their own behalf, however, and some patients never were able to do so. In such cases, it is critical to be aware of how to determine if a patient has the ability to make medical decisions and what should be done if they do not. Here, we examine the concept of decision-making capacity in oncology and explore situations in which patients may have altered/diminished capacity (e.g., depression, cognitive impairment, delirium, brain tumor, brain metastases, etc.) or never had decisional capacity (e.g., minor children, developmentally disabled adults). We describe fundamental principles to consider when caring for a patient with cancer who lacks decisional capacity. We then introduce strategies for capacity assessment and how clinicians might navigate scenarios in which their patients could lack capacity to make decisions about their cancer care. Finally, we explore ways in which pediatric and medical oncology can learn from one another with regard to these challenging situations. Patients w/ #cancer sometimes lack capacity to make decisions about their medical care. How best to navigate these complex, stressful cases?