Multidisciplinary Assessment of Fitness to Drive in Brain Tumour Patients in Southwestern Ontario: A Grey Matter

Abstract

Background: Neurocognitive impairments from brain tumours may interfere with the ability to drive safely. In 9 of 13 Canadian provinces and territories, physicians have a legal obligation to report patients who may be medically unfit to drive. To complicate matters, brain tumour patients are managed by a multidisciplinary team; the physician most responsible to make the report of unfitness is often not apparent. The objective of the present study was to determine the attitudes and reporting practices of physicians caring for these patients. Methods: A 17-question survey distributed to physicians managing brain tumour patients elicited: (1) Respondent demographics; (2) Knowledge about legislative requirements; (3) Experience of reporting Barriers and attitudes to reporting. Fisher exact tests were performed to assess differences in responses between family physicians (fps) and specialists. Results: Of 467 physicians sent surveys, 194 responded (42%), among whom 81 (42%) were specialists and 113 (58%) were fps. Compared with the specialists, the fps were significantly less comfortable with reporting, less likely to consider reporting, less likely to have patients inquire about driving, and less likely to discuss driving implications. A lack of tools, concern for the patient–physician relationship, and a desire to preserve patient quality of life were the most commonly cited barriers in determining medical fitness of patients to drive. Conclusions: Legal requirements to report medically unfit drivers put physicians in the difficult position of balancing patient autonomy and public safety. More comprehensive and definitive guidelines would be helpful in assisting physicians with this public health issue.

A systematic review of the impact of brain tumours on risk of motor vehicle crashes

“…In an Australian survey of 194 practicing neurosurgeons, radiation oncologists and neurologists, 73% of respondents were not aware of guidelines and only 38% of doctors discussed driving restrictions with patients [ 20 ]. North American studies have reported similar findings [ 15 , 17 , 18 ].…”