Neuropsychological Predictors of Decision-Making Capacity in Terminally Ill Patients With Advanced Cancer

Arch Clin Neuropsychol. 2019 Jan 24;35(1):1-9. doi: 10.1093/arclin/acz027.


Objective: The purpose of this cross-sectional study was to identify the neuropsychological underpinnings of decision-making capacity in terminally ill patients with advanced cancer.

Method: Participants were 108 English-speaking adults. More than half (n = 58) of participants had a diagnosis of advanced cancer and were receiving inpatient palliative care; the rest were healthy adults. Participants completed a measure of decision-making capacity that assesses four legal standards of capacity (Choice, Understanding, Appreciation, and Reasoning), and several measures of neuropsychological functioning.

Results: Patients with terminal cancer were significantly more impaired on measures of capacity and neuropsychological functioning. Surprisingly, in the terminally ill sample, there were no significant correlations between neuropsychological functioning and decision-making capacity.

Conclusion: The terminally ill sample exhibited high levels of neuropsychological impairment across multiple cognitive domains. However, few of the measures of neuropsychological functioning were significantly associated with performance on the decisional capacity subscales in the terminally ill sample. It is possible that end-of-life decisional capacity is governed by general, rather than domain-specific, cognitive abilities.

Keywords: Cancer; Decision-making capacity; End-of-life; Palliative care.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comprehension
  • Cross-Sectional Studies
  • Decision Making*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / psychology*
  • Neuropsychological Tests
  • Problem Solving
  • Terminally Ill / psychology*