Capacity to make medical treatment decisions in multiple sclerosis: A potentially remediable deficit

Abstract

Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a core component of decisional capacity, in 36 people with MS and 16 normal controls. MS patients with diminished neuropsychological function showed poor understanding of treatment disclosures compared to the control group, and diminished new-learning and executive function correlated with poorer understanding. Nonetheless, with sufficient cueing, the MS patients with diminished neuropsychological function were able to display understanding that was equivalent to the control group. Implications of these results for clinical practice and medical research involving people with MS are discussed.

Ethics in Psychiatric Research: A Review of 25 Years of NIH-Funded Empirical Research Projects

“…Third, the risk factors for decisional incapacity associated with the psychiatric diagnoses listed above may be no greater than those associated with several medical conditions (Basso et al 2010; Luebbert et al 2008). …”

Capacity for financial decision making in multiple sclerosis

“…Furthermore, as many as 65% of patients manifest significant cognitive impairment (Chiaravalloti & DeLuca, 2008; Rao, Leo, Bernardin, & Unverzagt, 1991a), and these deficits correspond with degraded activities of daily living (Basso, Shields, Lowery, Ghormley, Combs, Arnett, & Johnson, 2008; Chiaravalloti, DeLuca, Moore, & Ricker, 2005; Rao, Leo, Ellington, Nauertz, Bernardin, & Unverzagt, 1991b). For instance, neuropsychological dysfunction correlates with increased unemployment, diminished work performance, reduced psychosocial function, compromised ability to provide informed consent to medical treatment, and degraded management of daily domestic activities (Basso, Candilis, Johnson, Ghormley, Combs, & Ward, 2010; Baughman, Basso, Sinclair, Combs, & Roper, 2015; Rao et al, 1991b). …”

Executive functions in adolescents with spina bifida: Relations with autonomy development and parental intrusiveness

“…Yet, studies with other populations have also found support for the relationship between EF and autonomy. For instance, much research examining decision-making capacity, a specific manifestation of autonomy, has found that higher EF predicts more independence in medical decision making (e.g., Basso et al, 2010; Dreer, DeVivo, Novack, Krzywanski, & Marson, 2008).…”