The Journal of Oncology Practice published a particularly interesting bioethics article entitled "Clinical Ethics Consultation in Oncology" in the September 2013 edition. The LIBERTARIAN BIOETHIC BLOGger's career as a radiation oncologist is the reason he found this paper so intriguing. The authors, Andrew Shuman et al, retrospectively reviewed the clinical ethics consultations at two National Cancer Institute-designated comprehensive cancer centers.
The conduct of this research was greatly facilitated by the existence of prospectively maintained clinical ethics consultation databases. This is an outstanding idea. In addition, the quality of the case reviews in this study was impressive. "Multiple study authors independently reviewed raw data (medical records including the documentation of the ethics consultation) and classified consultations accordingly; in cases of disagreement, authors discussed and reached a consensus." I assure readers that such raw data evaluations are tedious and time-consuming.
Two hundred eight (208) bioethics consults were noted. The most common issues leading to request of the ethics consult were code status and advance directives (approximately 25%). The most common persons to request the bioethics consults were the relevant attending physicians (approximately 61%). Interpersonal conflict occurred in approximately 51% of patient cases, primary between staff and family. Communication lapses were identified in approximately 45% of cases. The ethics consultant(s) recommended additional evaluations in approximately 58% of cases, principally by social work departments. Patient do-not-resuscitate (DNR) orders increased from approximately 26% of cases prior to the bioethics consult to approximately 60% of cases after the bioethics consult.
The authors rightly made no novel conclusions from their study due its retrospective nature.
I view this study as a fascinating "snapshot" of a typical bioethics consult for oncology patients in the latter half of the first decade of the 21st century.
The conduct of this research was greatly facilitated by the existence of prospectively maintained clinical ethics consultation databases. This is an outstanding idea. In addition, the quality of the case reviews in this study was impressive. "Multiple study authors independently reviewed raw data (medical records including the documentation of the ethics consultation) and classified consultations accordingly; in cases of disagreement, authors discussed and reached a consensus." I assure readers that such raw data evaluations are tedious and time-consuming.
Two hundred eight (208) bioethics consults were noted. The most common issues leading to request of the ethics consult were code status and advance directives (approximately 25%). The most common persons to request the bioethics consults were the relevant attending physicians (approximately 61%). Interpersonal conflict occurred in approximately 51% of patient cases, primary between staff and family. Communication lapses were identified in approximately 45% of cases. The ethics consultant(s) recommended additional evaluations in approximately 58% of cases, principally by social work departments. Patient do-not-resuscitate (DNR) orders increased from approximately 26% of cases prior to the bioethics consult to approximately 60% of cases after the bioethics consult.
The authors rightly made no novel conclusions from their study due its retrospective nature.
I view this study as a fascinating "snapshot" of a typical bioethics consult for oncology patients in the latter half of the first decade of the 21st century.
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