晚期癌症终末期患者决策能力的神经心理学预测因素
Neuropsychological Predictors of Decision-Making Capacity in Terminally Ill Patients with Advanced Cancer.
作者信息
Kolva Elissa, Rosenfeld Barry, Saracino Rebecca M
机构信息
Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO USA.
Department of Psychology, Fordham University, Bronx, NY USA.
出版信息
Arch Clin Neuropsychol. 2019 Jan 24;35(1):1-9. doi: 10.1093/arclin/acz027.
OBJECTIVE
The purpose of this cross-sectional study was to identify the neuropsychological underpinnings of decision-making capacity in terminally ill patients with advanced cancer.
METHOD
Participants were 108 English-speaking adults. More than half (n = 58) of participants had a diagnosis of advanced cancer and were receiving inpatient palliative care; the rest were healthy adults. Participants completed a measure of decision-making capacity that assesses four legal standards of capacity (Choice, Understanding, Appreciation, and Reasoning), and several measures of neuropsychological functioning.
RESULTS
Patients with terminal cancer were significantly more impaired on measures of capacity and neuropsychological functioning. Surprisingly, in the terminally ill sample, there were no significant correlations between neuropsychological functioning and decision-making capacity.
CONCLUSION
The terminally ill sample exhibited high levels of neuropsychological impairment across multiple cognitive domains. However, few of the measures of neuropsychological functioning were significantly associated with performance on the decisional capacity subscales in the terminally ill sample. It is possible that end-of-life decisional capacity is governed by general, rather than domain-specific, cognitive abilities.
目的
本横断面研究旨在确定晚期癌症终末期患者决策能力的神经心理学基础。
方法
研究对象为108名说英语的成年人。超过半数（n = 58）的参与者被诊断为晚期癌症，正在接受住院姑息治疗；其余为健康成年人。参与者完成了一项决策能力测试，该测试评估能力的四项法律标准（选择、理解、鉴赏和推理）以及多项神经心理学功能测试。
结果
终末期癌症患者在能力和神经心理学功能测试中的受损程度明显更高。令人惊讶的是，在终末期患者样本中，神经心理学功能与决策能力之间没有显著相关性。
结论
终末期患者样本在多个认知领域表现出高水平的神经心理学损伤。然而，在终末期患者样本中，很少有神经心理学功能测试与决策能力子量表的表现显著相关。临终决策能力可能由一般认知能力而非特定领域认知能力所决定。
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