Characteristics and outcomes of ethics consultations on a comprehensive cancer center’s gastrointestinal medical oncology service Journal Article
| Authors: | Corbett, V.; Epstein, A. S.; McCabe, M. S. |
| Article Title: | Characteristics and outcomes of ethics consultations on a comprehensive cancer center’s gastrointestinal medical oncology service |
| Abstract: | The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database (which includes categorization of the primary issues, contextual ethical issues, and other case characteristics) of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were identified. The most common primary ethical issue was the DNR order (39%), followed by medical futility (28%). The most common contextual issues were dispute/conflict between staff and family (48%), dispute/conflict intra-family (16%), and cultural/ethnic/religious issues (16%). The majority of ethical issues leading to consultation were resolved (84%); i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlierend of life care planning. © Springer Nature B.V. 2018. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; retrospective studies; case control study; case-control studies; organization and management; psychology; oncology; retrospective study; gastrointestinal neoplasms; cancer center; medical oncology; cancer care facilities; interpersonal communication; decision making; ethics; standards; end of life; decision-making; gastrointestinal tumor; negotiating; very elderly; ethics consultation; cancer; humans; human; male; female |
| Journal Title: | HEC Forum |
| Volume: | 30 |
| Issue: | 4 |
| ISSN: | 0956-2737 |
| Publisher: | Springer |
| Date Published: | 2018-12-01 |
| Start Page: | 379 |
| End Page: | 387 |
| Language: | English |
| DOI: | 10.1007/s10730-018-9357-4 |
| PUBMED: | 30078063 |
| PROVIDER: | scopus |
| PMCID: | PMC6263815 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 June 2019 -- Source: Scopus |
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