Neurocognitive testing along with a road test or simulated driving test are the best approach to gauging whether palliative care patients can drive safely.
In a recently published review on palliative care patients and driving, it was stated that:
• Palliative care patients should be counseled about driving because some may perform poorly on independent measures of driving ability, putting them at increased risk of traffic accidents.
• There is insufficient evidence to recommend a particular neurocognitive test (or battery of tests) to screen a patient group; however, 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 6 involving patients with multiple sclerosis, 4 of patients with Huntington's disease, and the rest of patients with heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease, or cancer.
• 13 of the studies found significant differences in road-test and simulated driving scores between palliative-care patients and controls.
• 9 studies found a correlation between driving safety and tests of divided attention. From 19% to 47% of patients with MS or Huntington's disease failed a road test or simulated driving test.
One author commented that there is precision on how to approach a situation where a patient's cancer has spread to the brain, but it is not clear how to do so with patients who have widespread cancer not involving the brain. The data is vague 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."
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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.