Neuro-oncology patients make decisions over their disease course that range in complexity. Clinicians must ensure patients have the decision-making capacity for specific decisions. One decision (in some jurisdictions) is whether to pursue physician-assisted suicide, or medical assistance in dying (MAiD). This is increasingly important as more jurisdictions legalize MAiD. The aim of this scoping review was to explore patient decision-making capacity in neuro-oncology, including measures of capacity and predictors of incapacity for end-of-life decision-making.

We conducted two literature searches (“decision making capacity and neuro-oncology” and “MAiD and neuro-oncology”) in five databases.

We aimed to review the existing literature around capacity assessment in neuro-oncology, the prevalence of incapacity in this patient population, and factors that might predict incapacity. We also aimed to highlight gaps in the literature around MAiD in neuro-oncology.

Standardized tools are available that can supplement clinical capacity assessment. Specific cognitive tests can suggest which domain of capacity is likely to be affected and can guide subsequent intervention. Clinical factors such as tumor grade and various treatments may impact capacity and cognition. In a brain cancer population, the prevalence of incapacity for healthcare decisions is 50-61%. Very little has been published about MAiD in neuro-oncology patients.

There is an established understanding of tools to assess decision-making capacity, but ultimately clinical gestalt is still important. More research is needed to understand whether specific tumor features (e.g., location, size) are implicated in incapacity in general, and specifically in decision-making capacity for end-of-life treatment options, including MAiD.