title: Clinical ethics consultation in patients with head and neck cancer.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.forename: Mary S
authors.initials: MS
authors.lastname: McCabe
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fins
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000941:ethics*; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015331:Cohort Studies; D016208:Databases, Factual; D033061:Ethics Consultation / Q000458:organization & administration*; D026690:Ethics, Clinical; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics / Q000379:methods; D011787:Quality of Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000941:ethics*; D019452:Terminally Ill; D055815:Young Adult