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Content review of pediatric ethics consultations at a cancer center
Author(s) -
Winter Meredith C.,
Friedman Danielle Novetsky,
McCabe Mary S.,
Voigt Louis P.
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27617
Subject(s) - medicine , family medicine , pediatric oncology , pediatric cancer , content analysis , coding (social sciences) , schema (genetic algorithms) , specialty , obligation , nursing , cancer , social science , statistics , mathematics , machine learning , sociology , computer science , political science , law
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.