A Contemporary Analysis of Ethics Consultations in an Oncologic ICU.

SESSION TYPE: End of Life Care PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: There are limited data describing ethics consultations among patients with cancer admitted to the intensive care unit (ICU). Our objective was to review and analyze ethics consultations in the ICU of a tertiary care cancer center.METHODS: Using ICU and hospital databases, we identified adult patients with cancer who were admitted to the ICU and had an ethics consultation between September 2007 and December 2011. Demographic and clinical variables were abstracted along with the details and context of the ethics consultation.RESULTS: A total of 53 ethics consultations were identified (representing 1% of ICU admissions during the study period). Over 70% of these patients were mechanically ventilated and/or received vasopressors. At the time of ethics consultation, 26% had do-not resuscitate (DNR) orders and 13% had an advance directive. After ethics consultation, the number of patients with DNR increased to 72%. Approximately 50% of the consultations involved interpersonal conflicts and/or issues with communication. Ethical dilemmas most commonly included discussion of code status (28%), medical futility (23%), and withdrawal/withholding of life-sustaining therapies (14%). ICU mortality was 51% and an additional 26% died in the hospital post-ICU discharge. Twelve patients (23%) were discharged: 6 to home and/or hospice and 6 to other inpatient facilities.CONCLUSIONS: The majority of ethics consultations among patients with cancer admitted to the ICU involve end-of-life issues, specifically regarding delineation of goals of care and the limitation of life-sustaining therapies. Communication barriers and interpersonal conflicts figure prominently in these consultations.CLINICAL IMPLICATIONS: Critical care physicians need to transcend communication barriers and forge partnerships with patients with cancer and their surrogates, and with other collaborating physicians to arrive at mutually agreeable solutions that balance patient's wishes with difficult realities.DISCLOSURE: The following authors have nothing to disclose: Sunil Kamat, Prabalini Rajendram, Andrew Shuman, Louis Voigt, Natalie Kostelecky, Mary McCabe, Stephen Pastores, Neil HalpernNo Product/Research Disclosure InformationMemorial Sloan Kettering Cancer Center, New York, NY.