Meredith C Winter1, Danielle Novetsky Friedman2,3,4, Mary S McCabe5, Louis P Voigt4,6,7. 1. Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York. 2. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, New York. 3. Department of Pediatrics, Weill Cornell Medical College, New York City, New York. 4. Ethics Committee, Memorial Sloan Kettering Cancer Center, New York City, New York. 5. National Coalition for Cancer Survivorship, Silver Spring, Maryland. 6. Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York. 7. Department of Anesthesiology, Weill Cornell Medical College, New York City, New York.
Abstract
BACKGROUND/ OBJECTIVES: Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center. DESIGN/ METHODS: We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation-specific data were also collected. RESULTS: Thirty-five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema-four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk-benefit analysis in the setting of an invasive procedure with uncertain benefit. CONCLUSIONS: Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end-of-life care and included a diversity of communication conflicts.
BACKGROUND/ OBJECTIVES: Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center. DESIGN/ METHODS: We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation-specific data were also collected. RESULTS: Thirty-five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema-four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk-benefit analysis in the setting of an invasive procedure with uncertain benefit. CONCLUSIONS: Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end-of-life care and included a diversity of communication conflicts.
Authors: Smita Bhatia; Wendy Landier; Muyun Shangguan; Lindsey Hageman; Alexandra N Schaible; Andrea R Carter; Cara L Hanby; Wendy Leisenring; Yutaka Yasui; Nancy M Kornegay; Leo Mascarenhas; A Kim Ritchey; Jacqueline N Casillas; David S Dickens; Jane Meza; William L Carroll; Mary V Relling; F Lennie Wong Journal: J Clin Oncol Date: 2012-05-07 Impact factor: 44.544
Authors: Ugur Sener; Elizabeth C Neil; Amy Scharf; Alan C Carver; Justin B Buthorn; Dana Bossert; Allison M Sigler; Louis P Voigt; Eli L Diamond Journal: Neurooncol Pract Date: 2021-06-19