Jessica A. Moore

Cancer Care Ethics in the Emergency Center

The emergency center (EC) is a technical, specialized, fast-paced environment where time is of the essence. Falling into a process by which the need for immediate response overshadows the need for ethical examination of important aspects of patient care is easy. Our purpose is to provide clinicians with some ethical considerations that can be made and reduce challenges to caring for the cancer patient in the EC. Cancer patients are often seen in ECs because of issues at the end of life, uncontrolled physical pain, and psychosocial or coping issues. This chapter deals with some of these and other common issues, including delirium, quickly changing condition, and possible drug-seeking behaviors for coping. Also considered are clinician responses to these as well as issues to recognize when assisting patients and their surrogates with decision-making during these difficult times. Case examples, discussion of the ethical challenges, and suggestions for the clinician and health care team are used to highlight and examine some of the ethical dilemmas faced in the EC.

Phase Angle and the Diagnosis of Impending Death in Patients with Advanced Cancer: Preliminary Findings

This article reports on the association between phase angle, which is measured by bioelectric impedance analysis and reflects cellular integrity and hydration level, and survival in patients with advanced cancer.

Ethical Issues for Children With Cancer

Abstract With approximately 15,000 children and adolescents diagnosed with cancer in United States each year, pediatric cancer is a relatively rare diagnosis, yet it remains the leading cause of death by disease in children. Fortunately, effective treatments are available for most pediatric cancers, with average cure rates nearing 80%. However, due to their developmental immaturity and need for parents or surrogate decision makers to make medical decisions on their behalf, a number of ethical issues must be considered during the treatment of a child with cancer. Indeed, ethical issues including consent to participate in research studies, refusal of care, and end-of-life decisions all provide additional challenges beyond the obvious efforts to treat a child diagnosed with cancer. This chapter will provide a brief overview of these topics with the purpose of stimulating interest and discussion in these issues.

Integrative Oncology and Ethics

Abstract Discussing with patients the use of complementary, alternative, and integrative medicine (CAIM) therapies can be a daunting task, especially for physicians with limited knowledge about the field. This chapter will examine some of the ethical issues commonly confronted by oncology health care professionals in regard to CAIM and suggest methods to address them. We will begin with an introduction to terms and concepts, a brief description of the evolution of complementary and integrative medicine, and a short discussion of the types of therapies. We hope to assist members of the interdisciplinary/multidisciplinary health care team better understand and responsibly and respectfully address the CAIM needs of his or her patient within the boundaries of proven science with the information provided in this chapter.

An Ethical Framework for Disclosing Individual Genetic Findings to Patients, Research Participants, and Relatives

Abstract Current advances in genetic screening, biomarker development, personalized medicine, and targeted therapeutics have generated unprecedented quantities of patient data. These data are becoming increasingly vital as instruments of patient care and research. However, the nature of genetic information is such that it has clinically actionable implications for the patient’s relatives. This chapter focuses on a practical framework for the disclosure of genetic information to not only the patient but also to the family members who may be impacted by these findings. The potential benefit and utility of this information is carefully balanced with reducing the possible risks and informational harms by the use of policy, institutional safeguards, and empowering patient autonomy through rigorous informed consent standards.

Experience Matters: A Partnership Between Patient and Physician

A patient-centered approach to medical decision making empowers patients but it also imposes new responsibilities upon them. Shared decision making neither relieves physicians of their obligation to guide patients when necessary nor obligates them to agree to patient requests that run counter to their deeply held moral convictions and professional integrity. The patient–physician relationship is now a reciprocal one, with rights and responsibilities on both sides. In this chapter, we will present clinical scenarios that illustrate ethical challenges that often arise during shared decision making, outline ethical principles that pertain to the scenarios, and describe key strategies and skills that physicians need to partner with the patient and family to develop the best plan of care.

Utilizing information and telehealth technology to enhance clinical ethics education outreach.

149 Background: Integrated Ethics provides continuing education monthly for physicians, nurses, social workers, and others to enhance knowledge and understanding of ethical challenges associated with patient care and research. These are offered live at the main campus. There are four regional centers within a thirty-five mile radius of the main campus. Participants from those locations used to have to come to the main campus to participate. This project was initiated to help alleviate rising financial costs associated with the online recording/redistributing of continuing education credit presentations, travel expenses for regional center employees, removal of employees for 4+ hours from the regional centers daily clinical operations to attend presentations, and payment to outside institutions to obtain required ethics CME and CEU credits. METHODS Steps included internal and external discussions, establishing the need, tracking current process, determining which resources were needed, and then updating the process and evaluating it. Among the primary elements was the inclusion of nursing leaders, physicians and social workers from the centers. Ethics staff went to each center for discussions which had the added value of building relationships. Telehealth and information technology representatives assisted in developing the possible methods for delivery of the education and provided information about the process and costs of each for evaluation. Of note was the fact that the profession of the attendees was different among the main campus and regional centers. At main campus 58% of the attendees are physicians, at the regional center 66% are nurses. Varying requirements for continuing education in the professions had to be accounted for in the selection of method delivery and accreditation processes. RESULTS This project saves a minimum of

Are We Prepared for Surrogate Decision Making in the Internet Age

22,634 annually and participation at the Regional Care Centers increased by 20%. An average of 309 productivity hours are no longer lost at the centers. CONCLUSIONS Understanding and utilizing new technology and consistent personalized communication efforts realized both cost savings and increased participation.