Knowing your patient’s beliefs and goals is key to providing ethical cancer care.
Ethical dilemmas are unavoidable when caring for patients with cancer, and oncology nurses are often tasked with resolving such issues, relying on professional codes and standards to help guide what is best for the patient.
“One thing about ethical issues is that there’s usually not a right or a wrong. We’ve always tried to go for the best solution for the patient and the family, as well as the care team in the situation,” said Joyce Neumann, PhD, APRN, AOCN, BMTCN, FAAN, an advanced practiced registered nurse and adjuvant ethicist at The University of Texas MD Anderson Cancer Center. Neumann recently led a presentation on ethical dilemmas in oncology nursing at the 46th Annual ONS Congress.
While end-of-life care can highlight ethical dilemmas, the challenges actually start at diagnosis, when nurses are faced with educating patients and their family members, determining goals of care, discussing clinical trial participation, and assessing patients physically, cognitively, and psychologically.
Then comes the informed consent process, preparing for possible outcomes of treatment, establishing advanced care planning and goals of care – both through treatment and potentially at the end of life.
For example, nurses may need to balance being positive and providing hope with providing realistic information and expectations to patients and their loved ones.
Neumann explained that there were 669 ethics consults at MD Anderson between September 2015 and August 2020; 29% were filed by nurses. The most common reasons for these requests were inquiring about the appropriate levels of treatment.
“Probably the most major ethical challenge that we come to is when is enough enough, and when do we transition patients from curative or aggressive care to comfort care?” Neumann said.
One major way to address these ethical dilemmas in cancer care is to promote advanced care planning – where patients’ wishes, delegation of medical decision maker, and more are clearly documented for the patient, family, and clinical staff members.
Nurses should also consider patients’ comorbidities, prognosis, religious or spiritual views, and goals to help guide the best possible care.
“We obviously need to know patient preference – I can’t stress that enough,” Neumann said. “Does the patient have capacity for their decisions and those type of questions on quality of life? What does that mean to the patient? … If the patient does not have the capacity, can the family explain to us what conversations they’ve had with the patient prior to treatment starting, [regarding] views of care?”