Ethical Consultation Utilization Patterns in Adolescent and Young Adult Oncology: A 10-Year Single-Center Study and Contemporary Ethics Framework.

BACKGROUND

Adolescents and young adults (AYAs; 15-39 years) with cancer face unique ethical challenges. Variations in ethics consultations (ECs) among different AYA age groups remain understudied, despite evolving developmental and psychosocial milestones.

METHODS

A 10-year retrospective review at an academic medical center examined EC cases in AYA oncology patients. Ethicists categorized ethical issues using an institutional 5 domains, 23-category classification schema Decisional Processes, Medical/Surgical Treatments, Patient/Family Behavior, Professional Issues, and Information/Communication. Categories included surrogate decision-making, informed consent, pain management, and resuscitation status/do-not-resuscitate (DNR) order. Multiple categories could be documented per EC. Primary outcomes were (1) the distribution of categories across domains and (2) the prevalence of specific categories among patients, compared across age groups (15-21, 22-29, and 30-39 years) using χ2 or Fisher's exact tests (α = 0.05).

RESULTS

Among 59 ECs (mean patient age 26.4 ± 7.1 years; 52.5% female), Decisional Processes accounted for 41% of category applications, followed by Medical/Surgical Treatments (25%), Patient/Family Behavior (12%), Professional Issues (12%), and Information/Communication (9%). A total of 153 categories were recorded. The most common were surrogate decision-making (45%), quality-of-life (QoL) considerations (37%, including QoL deliberations [20%] and treatment-related QoL concerns [17%]), informed consent (20%), and DNR (18%). The distribution was consistent across age groups, except for pain control, observed only in 22-29-year-olds (3/16; p = 0.014).

CONCLUSION

Decision-making primarily drove EC with consistent patterns across the AYA spectrum, except for pain control in 22-29-year-olds. Findings emphasize the need for structured decision-making approaches and age-specific pain management in AYA oncology.