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Clinical ethics consultation in oncology
Andrew G Shuman1, Sacha M Montas, Andrew R Barnosky
1Memorial Sloan-Kettering Cancer Center; Weill Cornell Medical College, New York, NY; and University of Michigan Hospitals, Ann Arbor, MI.
Journal of Oncology Practice
|August 15, 2013
Summary
Clinical ethics consultations for cancer patients often involve complex decisions about care goals and advance directives. Improving communication and palliative care integration can enhance patient care and decision-making.
Area of Science:
- Oncology
- Bioethics
- Healthcare Management
Background:
- Limited research exists on clinical ethics consultations in oncology.
- Understanding these consultations is vital for improving cancer care.
Purpose of the Study:
- To review and describe clinical ethics consultations in adult cancer patients.
- Identify system improvements and educational opportunities for staff.
Main Methods:
- Case series analysis of ethics consultations from 2007-2011.
- Included adult cancer patient cases from two comprehensive cancer centers.
Main Results:
- 208 cases reviewed; common issues included code status, advance directives, surrogate decision-making, and medical futility.
- Communication lapses (45%) and interpersonal conflict (51%) were frequent.
- Do-not-resuscitate orders increased from 26% to 60% post-consultation; palliative care consulted in 41% of cases.
Conclusions:
- Ethics consultations highlight the complexity of cancer patient management.
- Honoring patient wishes within care goals is crucial.
- Addressing communication, conflict, palliative care, and end-of-life care is key for optimal patient outcomes.
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