Neurocognitive testing along with a road test or simulated driving test are the best approach to gauging whether palliative care patients can drive safely.
Information from different authors:
• Palliative care patients should be counselled about driving because there is a proportion that may perform poorly on these measures of driving ability, and they may be at increased risk of road-traffic incidents”
• There is insufficient evidence to recommend a particular neurocognitive test (or battery of tests) to screen a patient group that would be cared for by specialist palliative care services - impairment in divided attention has shown association with road test or simulated driving scores in MS, heart failure and Huntington's disease patients.
• Palliative-care patients have progressive incurable illnesses, comorbidities and medications to manage their symptoms, raising concerns about whether they should continue to drive.
Authors reviewed 14 articles, including six in patients with multiple sclerosis, four in Huntington's disease patients, and the rest in patients with heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease or cancer.
• Thirteen of the studies found significant differences in road-test and simulated driving scores between palliative-care patients and controls.
• Nine found a correlation between driving safety and tests of divided attention. From 19 % - 47 % of patients with MS or Huntington's disease failed a road test or simulated driving test.
One author comment that there is precision on how to approach a situation where a patient's cancer that has spread to their brain, but it is not clear about patients with widespread cancer not involving their brain, such as in their bones, liver and lungs - there are vaguely data on how many patients in this situation continue to drive.
When patients do wish to keep driving "extra care must be taken to ensure that the treatments (such as pain medications or sedatives) are not compromising this ability."
See reference for more information.
Adapted from Harding A. News @ Perspective. Palliative-care patients perform worse on tests of driving safety. Internet. Available at https://www.medscape.com/viewarticle/906906?src=wnl_edit_tpal&uac=6705FY&impID=1849170&faf=1 Accessed on May 20, 2019. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.