Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns.
Identifieur interne : 002252 ( Ncbi/Merge ); précédent : 002251; suivant : 002253Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns.
Auteurs : Muneer Abu Snineh [Canada] ; Richard Camicioli [Canada] ; Janis M. Miyasaki [Canada]Source :
- Parkinsonism & related disorders [ 1873-5126 ] ; 2017.
Abstract
Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia.
DOI: 10.1016/j.parkreldis.2017.03.006
PubMed: 28336349
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Electronic address: abusnine@ualberta.ca.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic</wicri:regionArea><wicri:noRegion>Kaye Edmonton Clinic</wicri:noRegion></affiliation></author><author><name sortKey="Camicioli, Richard" sort="Camicioli, Richard" uniqKey="Camicioli R" first="Richard" last="Camicioli">Richard Camicioli</name><affiliation wicri:level="1"><nlm:affiliation>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada. Electronic address: rcamicio@ualberta.ca.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic</wicri:regionArea><wicri:noRegion>Kaye Edmonton Clinic</wicri:noRegion></affiliation></author><author><name sortKey="Miyasaki, Janis M" sort="Miyasaki, Janis M" uniqKey="Miyasaki J" first="Janis M" last="Miyasaki">Janis M. Miyasaki</name><affiliation wicri:level="1"><nlm:affiliation>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada. Electronic address: Miyasaki@ualberta.ca.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic</wicri:regionArea><wicri:noRegion>Kaye Edmonton Clinic</wicri:noRegion></affiliation></author></analytic><series><title level="j">Parkinsonism & related disorders</title><idno type="eISSN">1873-5126</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">28336349</PMID><DateCreated><Year>2017</Year><Month>03</Month><Day>24</Day></DateCreated><DateRevised><Year>2017</Year><Month>03</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1873-5126</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2017</Year><Month>Mar</Month><Day>08</Day></PubDate></JournalIssue><Title>Parkinsonism & related disorders</Title><ISOAbbreviation>Parkinsonism Relat. Disord.</ISOAbbreviation></Journal><ArticleTitle>Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">S1353-8020(17)30087-1</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.parkreldis.2017.03.006</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Fifty consecutive PD patients were recruited from the Movement Disorders Program. Mini Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the MacArthur Competency Assessment Test (MacCAT) for GOC were administered.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Mean MMSE and MOCA was 27.76 and 24.5 respectively. Twenty subjects had impaired executive function. MacCAT correlated with MoCA and MMSE (p < 0.001, 0.001) but despite impaired understanding, appreciation and reasoning among some subjects, all subjects expressed a choice.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This exploratory study demonstrates PD with cognitive concerns had a range in decisional capacity with lower MoCA and MMSE scores predicting impaired MacCAT subscores. Clinicians should be aware that cognitive complaints without dementia may impact capacity. Despite impairments in understanding, appreciation or reasoning, patients may still express a choice. Hence, a choice in this setting may not represent their true values and goals. GOC discussions require explicit determination of the domains of capacity. Discussions regarding GOC should occur early in the course of PD.</AbstractText><CopyrightInformation>Copyright © 2017 Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Abu Snineh</LastName><ForeName>Muneer</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada. Electronic address: abusnine@ualberta.ca.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Camicioli</LastName><ForeName>Richard</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada. Electronic address: rcamicio@ualberta.ca.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Miyasaki</LastName><ForeName>Janis M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Division of Neurology, Department of Medicine, University of Alberta, Kaye Edmonton Clinic, Canada. Electronic address: Miyasaki@ualberta.ca.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>03</Month><Day>08</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Parkinsonism Relat Disord</MedlineTA><NlmUniqueID>9513583</NlmUniqueID><ISSNLinking>1353-8020</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Advance care directives</Keyword><Keyword MajorTopicYN="N">Capacity to consent</Keyword><Keyword MajorTopicYN="N">Cognitive</Keyword><Keyword MajorTopicYN="N">Cognitive complaints</Keyword><Keyword MajorTopicYN="N">Executive function</Keyword><Keyword MajorTopicYN="N">Goals of Care</Keyword><Keyword MajorTopicYN="N">POLST</Keyword><Keyword MajorTopicYN="N">Parkinson's disease</Keyword><Keyword MajorTopicYN="N">Physician Orders for Life Sustaining Therapies</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>01</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>02</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>03</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>3</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>3</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>3</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28336349</ArticleId><ArticleId IdType="pii">S1353-8020(17)30087-1</ArticleId><ArticleId IdType="doi">10.1016/j.parkreldis.2017.03.006</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Abu Snineh, Muneer" sort="Abu Snineh, Muneer" uniqKey="Abu Snineh M" first="Muneer" last="Abu Snineh">Muneer Abu Snineh</name></noRegion><name sortKey="Camicioli, Richard" sort="Camicioli, Richard" uniqKey="Camicioli R" first="Richard" last="Camicioli">Richard Camicioli</name><name sortKey="Miyasaki, Janis M" sort="Miyasaki, Janis M" uniqKey="Miyasaki J" first="Janis M" last="Miyasaki">Janis M. 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