Table 2.

Preliminary Clinical Recommendations to Enhance Medical Decision Capacity in Brain Tumor Patients

Clinical recommendations
1	Health care professionals should try to involve patients in the decision-making process whenever possible.
2	Careful evaluation of medical decision-making capacity should be performed in brain tumor patients on a case-by-case basis, with multiple evaluations over time, particularly at the time a decision needs to be made.
3	Clinicians should be aware that they generally tend to overestimate patient’s medical decision-making capacity in different settings, which may affect the procedure for consent to treatment and research.
4	Screening of neurocognitive functioning (eg, bedside tests) could help in identifying those patients with impaired decisional capacity, for whom subsequent assessment with a validated capacity instrument should be initiated.
5	Health care professionals should try to enhance patients’ consent capacity by offering cues reducing memory or attention demands.
6	Patient information forms should contain simple language, use absolute terms, refrain from lengthy and irrelevant texts, and make use of pictures or figures when possible.
7	Physicians should address advanced care planning soon after diagnosis of a brain tumor. Because surrogate decisions are often necessary with progressive disease, relatives or other trusted individuals should be involved in the process of patients’ advanced care planning.
8	Surrogate decision making should be considered in case the patient lacks capacity, ensuring that the patient’s “best interests” and wishes are guaranteed.
9	If no surrogate is available for decisions in clinical practice, health care professionals should make the decision based on the patient’s “best interests.”