Original Article

Clinical ethics consultation in patients with head and neck cancer

Corresponding Author

Andrew G. Shuman MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

Division of Medical Ethics, Weill Cornell Medical College, New York, New York

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: [email protected]Search for more papers by this author

Mary S. McCabe RN, MA,

Mary S. McCabe RN, MA

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

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Joseph J. Fins MD, MACP,

Joseph J. Fins MD, MACP

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

Division of Medical Ethics, Weill Cornell Medical College, New York, New York

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Dennis H. Kraus MD,

Dennis H. Kraus MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

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Jatin P. Shah MD,

Jatin P. Shah MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

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Snehal G. Patel MD, FRCS,

Snehal G. Patel MD, FRCS

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

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Andrew G. Shuman MD,

Corresponding Author

Andrew G. Shuman MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

Division of Medical Ethics, Weill Cornell Medical College, New York, New York

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: [email protected]Search for more papers by this author

Mary S. McCabe RN, MA,

Mary S. McCabe RN, MA

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

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Joseph J. Fins MD, MACP,

Joseph J. Fins MD, MACP

Ethics Committee, Memorial Sloan–Kettering Cancer Center, New York, New York

Division of Medical Ethics, Weill Cornell Medical College, New York, New York

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Dennis H. Kraus MD,

Dennis H. Kraus MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

Search for more papers by this author

Jatin P. Shah MD,

Jatin P. Shah MD

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

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Snehal G. Patel MD, FRCS,

Snehal G. Patel MD, FRCS

Head and Neck Surgery Service, Memorial Sloan–Kettering Cancer Center, New York, New York

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First published: 17 November 2012

https://doi.org/10.1002/hed.23204

Citations: 16

This work was presented at the AHNS 8th International Conference on Head and Neck Cancer, Toronto, Canada, July 2012.

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Abstract

Background

The purpose of this study was to describe the impact of clinical ethics consultations among patients with head and neck cancer in order to better anticipate and manage clinical challenges.

Methods

A database was queried to identify patients with head and neck cancer for whom ethics consultation was performed at a comprehensive cancer center (n = 14). Information from the database was verified via data abstraction and analyzed qualitatively and quantitatively.

Results

Common requests for ethics consultation involved code status (6 of 14) and withdrawal/withholding life-sustaining treatments (6 of 14). Common contextual features were interpersonal conflicts (6 of 14) and communication barriers (5 of 14). Airway management concerns were frequent (5 of 14). Whereas 21% of patients had do not resuscitate (DNR) orders before ethics consultation, 79% were DNR subsequently.

Conclusion

Ethics consultations among patients with head and neck cancer reflect distinctive complexities inherent to their disease, but are entirely consistent with global clinical ethical themes. Consideration of communication barriers, social isolation/stigma, symptom control, and airway management are critical. © 2012 Wiley Periodicals, Inc. Head Neck, 35: 1647–1651, 2013

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Volume35, Issue11

November 2013

Pages 1647-1651

Clinical ethics consultation in patients with head and neck cancer

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Clinical ethics consultation in patients with head and neck cancer

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