Ethical issues in patients referred for palliative radiation therapy
Autor: | Virginia T. LeBaron, Tracy A. Balboni, Gregory M. Parker, Sonia Skamene, Divya Yerramilli, R. Shiloh, Monica Krishnan, Lauren Hertan, Alexander Spektor |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Palliative care Palliative Radiation Therapy media_common.quotation_subject education Morals Patient Care Planning Sex Factors Medicine Humans Spirituality Prospective Studies Neoplasm Metastasis Referral and Consultation Internal conflict media_common Aged Advanced and Specialized Nursing Response rate (survey) Aged 80 and over Cultural Characteristics Performance status business.industry Brain Neoplasms Palliative Care Radiation Oncologists Middle Aged Physical Functional Performance Distress Anesthesiology and Pain Medicine Feeling Socioeconomic Factors Family medicine Female business Psychosocial |
Zdroj: | Annals of palliative medicine. 8(3) |
ISSN: | 2224-5839 |
Popis: | Background: As patients with advanced cancer approach end of life, ethical issues may arise. We describe ethical issues encountered by radiation oncologists in this setting. Methods: A prospective, survey-based study assessed 162 consecutive consults for palliative radiation therapy (PRT) over 4 months at 3 hospitals. Consulting radiation clinicians completed a survey assessing palliative care issues encountered, based on national guidelines. Ethical issues included 5 subthemes (conflict between clinicians, caregiver-clinician conflict, internal conflict, feeling unable to do what was best for the patient, and violation of personal morals), an option for unclassified issues, and open-ended responses. Multivariate analyses (MVA) assessed potential patient-related predictors of ethical issues: gender, performance status (PS), PRT indication, physical symptoms, and presence of psychosocial, goals of care, care coordination, cultural, or spiritual issues. Results: Of 162 surveys, 140 were completed (response rate =86%). Overall, 14 (10%) surveys identified ethical issues relevant to care; 11 of 14 (78%) identified more than 1 ethical issue. Half (7; 50%) involved conflict between clinicians and clinician-caregiver conflict; 6 (43%) involved clinician distress or internal conflict; and 2 (14%) felt impeded from doing what they felt was best for the patient. Open-ended responses revealed differences in opinion between medical specialties (n=6, 43%), and conflict related to coordination of care among clinicians (n=3, 21%). On UVA, ethical issues were associated with PRT referrals for bleeding, dyspnea, or dysphagia due to visceral metastases (30%) versus CNS indications such as brain metastases or cord compression (7%) or for bony metastases (4%) P |
Databáze: | OpenAIRE |
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