Use of a 3-stage capacity-consent process was possible and allowed for adequate time to show a patient’s capacity to be able to consent to proposed cancer treatment, according to new data presented at ESMO Congress 2022.
Demonstrating the capacity for medical decision-making must include: understanding the nature of the cancer, appreciation of the range of potential options, weighing up the pros and cons of each options, and the ability to reach a decision that is communicated.
Researchers from Beaumont RCSI Cancer Centre in Dublin, Ireland, presented information on their development of a 3-stage capacity-consent process performed during three occasions prior to delivery of cancer therapy.
“The decision to undergo systemic anti-cancer therapy by patients with cancer is a complicated process. The decision is based around many variables,” they wrote in their research abstract. “Consent requires that a person has the capacity to consent.”
In the 3-stage capacity-consent process, patients were initially assessed by a senior medical oncologist who was responsible for discussing the person’s cancer, the treatment options and side effects; and predicted outcomes for each option, and then planned an appropriate treatment. Later the same day, a liaison clinical nurse specialist further educated the patients on the aspects of the proposed treatment.
Within 10 days, the patient was reviewed with a different oncology doctor and a different clinical nurse specialist who answered any questions, gave further education, and proceeded to signing of consent. Patients could ask questions again on the day of treatment initiation.
During a 5-month period, 126 patients were included in a pilot study of the new system. The median age of patients was 65 years. About one-third (32%) of patients were consenting to immunotherapy-related regimens; 13% concurrent chemoradiotherapy, and about half (55%) to cytotoxic chemotherapy.
All patients were offered the new 3-stage capacity-consent process, and all engaged and fully participated.
According to the researchers, the several phases of consent built into the program allowed patients and their families “information processing time”. The pilot approach is now being expanded to all patients at the cancer center.