The Role of Radiation Oncology in Ethics Consultations

Abstract

Previous work has shown the frequency with which radiation oncology providers identify ethical issues at the time of palliative radiation referral. However, for patients with advanced cancer, ethical issues may arise at any time, and radiation oncologists may be concurrently consulted or interact with these patients on treatment. Thus, this study aims to describe ethics consultations placed at a large cancer center and explore the role of radiation oncology in these consults. A large retrospective single-institution database of all ethics consultations placed at a cancer center from 1/2010-12/31/2019 was analyzed (n = 760). Demographic, clinical, and ethics consultations were abstracted and coded by members of the ethics committee responding to the consultation. These were further coded for analysis as follows: End-of-Life included goals of care discussions, withdrawal of life-sustaining treatment, futility of treatment, and DNR discussions; Patient Autonomy included decision-making and patient capacity; Beneficence included issues around duty to treat or refusal of treatment. Univariate analysis was performed to examine the characteristics associated with radiation oncology involvement. Of 760 unique ethics consults placed, 50% (n = 380) involved patients who were male, and 50% (n = 380) involved patients who were female; 45% (n = 341) were Christian, 25% (n = 191) were Jewish, 22% (n = 61) did not list their religion, and 8% (n = 22) identified as another religion. Most patients were proficient in English (82.1%, n = 624), and 85% of patients were white. 665 consults were placed in the inpatient setting. 60% (n = 452) were placed by a physician, 31% (n = 234) were placed by another healthcare provider, 6% (n = 43) were placed by social work/patient representative, and only 2% (n = 15) were placed by the patient or family. Of all ethics consults, 55% (n = 416) involved end-of-life issues, 39% (n = 296) involved patient autonomy, 4% (n = 31) involved beneficence, and 2% (n = 17) involved other issues. Of these consults, 16% (n = 124) of the patients either received radiation within 30 days of ethics consult or had an inpatient consult for radiation placed. There were no significant differences in age, gender, race, or language-preference based on radiation oncology involvement. For consults involving radiation oncology, 58% (n = 72) involved end-of-life issues, 39% (n = 48) involved patient autonomy issues; 2% (n = 3) involved beneficence. On univariate analysis, there were no statistically significant differences for reason of ethics consultation based on radiation oncology involvement. About one in six ethics consultations may involve radiation oncologists. Over half of these consults involve end-of-life issues, such as futility, withdrawal of treatment and goals of care. As such, radiation oncologists have an important opportunity to be involved in these discussions.