Schulich School of Medicine and Dentistry, Western University, London, ON.
Curr Oncol. 2013 Feb;20(1):e4-e12. doi: 10.3747/co.20.1198.
Neurocognitive impairments from brain tumours may interfere with the ability to drive safely. In 9 of 13 Canadian provinces and territories, physicians have a legal obligation to report patients who may be medically unfit to drive. To complicate matters, brain tumour patients are managed by a multidisciplinary team; the physician most responsible to make the report of unfitness is often not apparent. The objective of the present study was to determine the attitudes and reporting practices of physicians caring for these patients.
A 17-question survey distributed to physicians managing brain tumour patients elicited Respondent demographicsKnowledge about legislative requirementsExperience of reportingBarriers and attitudes to reporting Fisher exact tests were performed to assess differences in responses between family physicians (fps) and specialists.
Of 467 physicians sent surveys, 194 responded (42%), among whom 81 (42%) were specialists and 113 (58%) were fps. Compared with the specialists, the fps were significantly less comfortable with reporting, less likely to consider reporting, less likely to have patients inquire about driving, and less likely to discuss driving implications. A lack of tools, concern for the patient-physician relationship, and a desire to preserve patient quality of life were the most commonly cited barriers in determining medical fitness of patients to drive.
Legal requirements to report medically unfit drivers put physicians in the difficult position of balancing patient autonomy and public safety. More comprehensive and definitive guidelines would be helpful in assisting physicians with this public health issue.
脑部肿瘤引起的神经认知障碍可能会影响安全驾驶的能力。在加拿大的 13 个省和地区中，有 9 个地区的医生有法律义务报告可能因身体原因不适合驾驶的患者。更复杂的是，脑肿瘤患者由多学科团队管理；最有责任报告不适合驾驶的医生通常并不明显。本研究的目的是确定治疗这些患者的医生的态度和报告实践。
一项针对管理脑肿瘤患者的医生的 17 个问题的调查，询问了受访者的人口统计学信息、立法要求的知识、报告经验、报告的障碍和态度。Fisher 确切检验用于评估家庭医生 (fps) 和专家之间的反应差异。
在发送给 467 名医生的调查中，有 194 名医生做出了回应（42%），其中 81 名（42%）是专家，113 名（58%）是 fps。与专家相比，fps 报告时的舒适度明显较低，不太可能考虑报告，不太可能有患者询问驾驶问题，也不太可能讨论驾驶影响。缺乏工具、担心医患关系以及希望维持患者的生活质量是确定患者驾驶医学适宜性的最常见障碍。
报告不适合驾驶的患者的法律要求使医生处于平衡患者自主权和公共安全的困境中。更全面和明确的指南将有助于医生解决这一公共卫生问题。
