We evaluated the use of the Macarthur Competence Assessment Tool for Treatment (MacCAT-T) to assess decision-making ability in glioma patients.

Despite the identified need for glioma patients to make difficult end-of-life decisions amongst cognitive limitations, there is no universal measurement of decision-making ability for this patient population. We sought to determine whether the MacCAT-T could identify deficits in individual decision-making domains that a gross cognitive exam or informal clinician assessment might not otherwise detect.

High-grade glioma patients were consented to an IRB-approved prospective study at three timepoints requiring treatment decisions: diagnosis, recurrence, or end of life. Patients completed the Montreal Cognitive Assessment (MoCA), and providers assessed whether patients had sufficient decision-making ability based on their neurologic exam.  The MacCAT-T – designed to assess patient decision-making domains (appreciation, reasoning, and understanding) – was administered by a research assistant. MoCA, MacCAT-T, and provider data were compared to determine if the MacCAT-T provided additional information.  To evaluate feasibility, we measured administration time and obtained qualitative patient feedback. 

11 patients (median age= 68, median KPS= 80-90) were enrolled. MacCAT-T administration took on average 18.5 minutes. 90% of patients reported “increased knowledge of their treatment options” after taking the MacCAT-T.  91% of patients were deemed by clinicians to possess sufficient decision-making ability. 7 patients yielded discordant data: 2 patients with MOCA score >26 showed qualitative impairments in reasoning on the MacCAT-T and 5 patients who scored <21 were within non-impaired ranges for three of four decision-making domains.

MacCAT-T administration was feasible and the interview process was informative to patients.  In the majority of patients, there was a discordance among MOCA, MacCAT-T, and clinician assessment data.  The MacCAT-T may help in identifying mild reasoning impairments related to patients’ initial treatment decisions and should be studied further to determine its role in clinical practice.