CN30 - Three stage capacity: Consent process for systemic anti-cancer therapy

Background

The decision to undergo systemic anti-cancer therapy by patients with cancer is a complicated process. The decision is based around many variables. Consent requires that a person has the capacity to consent. Medical decision making capacity must include the following attributes: understanding the nature of their cancer, appreciation of the range of potential options, weighing up the pros and cons of each option and the ability to reach a decision that is communicated. We sought to strengthen our approach to the consent process through a “3-stage capacity-consent process”, performed over 3 occasions prior to delivery of the relevant therapy.

Methods

All patients starting a new plan of intravenous therapy were offered participation in the “3-Stage Capacity-Consent Process”. Patients were initially assessed by a senior medical oncologist who discussed the person's cancer, the treatment options & side-effects, predicted outcomes with each approach, and planned an appropriate treatment. On the same day patients were further educated on the aspects of the proposed treatment by a liaison clinical nurse specialist. Within 10 days they were reviewed by a different oncology doctor and a different clinical nurse specialist who answered any questions posed, gave further education and proceeded to the signing of a consent to medical treatment form. On the day of the first dose of treatment patients were once again given the opportunity to ask questions of a doctor and oncology nurse prior to treatment administration.

Results

Between 4/21 and 9/21 126 patients were included in the pilot study. Female patients represented 37% of the cohort. The median age of patients was 65 yrs (range: 20-89). 32% of patients were consented for immunotherapy-related regimens. 13% were having concurrent chemotherapy-radiation therapy. The remaining 55% had cytotoxic chemotherapy. All patients offered the 3-stage process engaged and participated fully in the program.

Conclusions

A 3 stage capacity - consent process is possible, and allows several phases of “information processing time” by patients and their families, ensuring adequate time to show a patient's capacity to be able to consent to their proposed treatment. This pilot approach is being expanded to all patients attending our Cancer Centre.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Beaumont Hospital.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.