Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?

Weir, Nashringi; Fischer, Amanda; Good, Phillip

doi:10.1111/imj.13571

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…To our knowledge, this is the first systematic review evaluating driving in patients with brain tumours and incidence of MVC. To date, most published research has focused on clinician attitudes and practices towards driving guidelines [ 15 – 19 ]. Our review demonstrates a paucity of real-world data concerning MVC incidence amongst these patients.…”

Section: Discussionmentioning

confidence: 99%

“…A Canadian study evaluating driving recommendations among healthcare professionals, found that only 56% discussed driving recommendations with patients and only 9.3% could reliably determine fitness to drive [ 18 ] . In a survey of Australian and New Zealand palliative care clinicians, only 27% reported patients with brain tumours to driving authorities [ 19 ] . Similarly, a Canadian study demonstrated low mandatory reporting rates with poor documentation of medical discussions regarding safe driving [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of the impact of brain tumours on risk of motor vehicle crashes

Tran,

Lapidus,

Neal

et al. 2024

J Neurooncol

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Purpose Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. Methods A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. Results Three studies were included in this review. One cohort study, one cross-sectional study and one case–control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. Conclusion Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. Systematic review registration number PROSPERO 2023 CRD42023434608.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review of the impact of brain tumours on risk of motor vehicle crashes

Tran,

Lapidus,

Neal

et al. 2024

J Neurooncol

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“…Unfortunately, our sample size was too small to conduct statistical analyses on the implications of histological subtype on cognitive testing and driving performance. Other research in the field has shown that advanced intracranial disease is not only associated with increased tumor burden, increased utilization of adjuvant therapies such as radiation therapy, poorer cognition, and lower capacity for reasoning/decision-making, but also increased utilization of complex narcotic regimens 20 , 21 . The use of a new narcotic is associated with increased on-road collisions and traffic violations and for that reason amongst several others, many palliative care doctors would consider this subset of the neuro-oncological population at greater risk of unsafe driving 20 .…”

Section: Discussionmentioning

confidence: 99%

Driving habits and behaviors of patients with brain tumors: a self-report, cognitive and driving simulation study

Mansur

Hird

Desimone

et al. 2018

Sci Rep

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The purpose of the study is to determine driving habits and behaviors of patients with brain tumors in order to better inform discussions around driving safety in this population. Eight-four patients with brain tumors participated in a survey on their driving behaviors since their diagnosis. Thirteen of these patients and thirteen sex- and age-matched healthy controls participated in cognitive testing and several driving simulation scenarios in order to objectively assess driving performance. Survey responses demonstrated that patients with brain tumors engage in a variety of driving scenarios with little subjectve difficulty. On the driving simulation tasks, patients and healthy controls performed similarly except that patients had more speed exceedances (U = 41, p < 0.05) and a greater variability in speed (U = 57, p < 0.05). Performance on the selective attention component of the UFOV was significantly associated with greater total errors in the Bus Following task for patients with brain tumors compared to healthy controls (rs = 0.722, p < 0.05, CI [0.080, 0.957]). Better comprehensive driving assessments are needed to identify patients with driving behaviors that put themselves and others at risk on the road.

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“…Frequently, clinicians advise patients not to drive immediately after taking opioids. [45] There is a need for further research to understand if patients taking regular, low-dose, sustained-release morphine are able to drive safely given the different pharmacokinetic profile they have to immediate-release oral morphine solutions. [46] The relation between breathlessness and driving performance whist on opioids must also be explored as current legal morphine limits for driving (where imposed) are far higher than the doses used in this study.…”

Section: Main Findingsmentioning

confidence: 99%

Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study

et al. 2020

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Background: Chronic breathlessness is a disabling syndrome that profoundly impacts patients’ and caregivers’ lives. Driving is important for most people, including those with advanced disease. Regular, low-dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving. Aim: To understand patients’ and caregivers’ (1) perspectives and experiences of driving with chronic breathlessness; and (2) perceived impact of regular, low-dose, sustained-release morphine on driving. Design: A qualitative study embedded in a pragmatic, phase III, randomised, placebo-controlled trial of low-dose, sustained-release morphine (⩽32 mg/24 h) for chronic breathlessness. Semi-structured interviews were conducted immediately after participants withdrew or completed the randomised, placebo-controlled trial. Informed by grounded theory, a constant comparative approach to analysis was adopted. Setting/participants: Participants were recruited from an outpatients palliative care service in Adelaide, Australia. Participants included patients ( n = 13) with severe breathlessness associated with chronic obstructive pulmonary disease and their caregivers ( n = 9). Results: Participants were interviewed at home. Eleven received morphine 8–32 mg. Three themes emerged: (1) independence; (2) breathlessness’ impact on driving; and (3) driving while taking regular, low-dose, sustained-release morphine. Conclusion: Driving contributed to a sense of identity and independence. Being able to drive increased the physical and social space available to patients and caregivers, their social engagement and well-being. Patients reported breathlessness at rest may impair driving skills, while the introduction of sustained-release morphine seemed to have no self-reported impact on driving. Investigating this last perception objectively, especially in terms of safety, is the subject of ongoing work.

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Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?

Abstract: This is the first survey investigating the practice of Australian doctors in assessing fitness to drive of patients with advanced disease. The survey found wide variability in practice and substantial discordance with current driving guidelines.

Cited by 11 publications

References 17 publications

A systematic review of the impact of brain tumours on risk of motor vehicle crashes

A systematic review of the impact of brain tumours on risk of motor vehicle crashes

Driving habits and behaviors of patients with brain tumors: a self-report, cognitive and driving simulation study

Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study

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