1181 - End-of-Life Ethics Consultations in Radiation Oncology: An Analysis of Decision-Making, Medical Futility, and Goals of Care
Presenter(s)
P. McGinnis1, T. Brough1, A. Balaji1, Z. Keepers1, A. A. Olabumuyi2, and H. Silverman1; 1University of Maryland School of Medicine, Baltimore, MD, 2Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
Purpose/Objective(s): Radiation therapy is used for both definitive treatment and symptom palliation; however, determining when treatment no longer provides benefit remains ethically complex. Radiation oncologists frequently participate in end-of-life decision-making where patient autonomy, medical futility, and quality of life intersect. Limited literature exists exploring the ethical dilemmas prompting consultation in radiation oncology. We sought to describe the frequency, distribution, and outcomes of ethics consultations involving radiotherapy decision-making. We hypothesized that ethics consultations would most commonly focus on treatment appropriateness and decisional capacity.
Materials/Methods: We performed a retrospective review of ethics consultation cases from 2016–2024 that involved radiotherapy or oncologic treatment decisions. Cases were identified using a Python-based keyword search of all consultations at an academic medical center. Extracted variables included demographics, oncologic history, and final consultation recommendations. Ethical issues were categorized into five domains: medical futility/treatment appropriateness; decisional capacity and surrogate decision-making; goals of care and end-of-life decision-making; refusal of care; and systems-level/disposition concerns. Descriptive statistics were used for analysis.
Results: Of 788 ethics consultations during the study period, 52 (6.6%) involved radiation oncology. Most cases involved patients with advanced or metastatic malignancies requiring time-sensitive decisions. Median age was 66.8 years (IQR 62.3–78.4); 69.2% were Black or African American, 28.8% White, and 55.8% female. The most frequent ethical issues were medical futility/treatment appropriateness (32.7%), decisional capacity/surrogate decision-making (26.9%), and goals of care/end-of-life decisions (25.0%). Ethics recommendations commonly advised limiting or withholding disease-directed therapy (32.1%) or formally assessing decisional capacity and identifying a legally authorized surrogate (26.4%). In 20.8% of cases, transition to comfort-focused or hospice care was recommended. Consultations frequently addressed discordance between requested radiotherapy and anticipated clinical benefit.
Conclusion: Ethics consultations involving radiation oncology most often arise in advanced malignancy when treatment appropriateness, decisional capacity, and surrogate authority are uncertain. These findings highlight the ethical complexity of time-sensitive radiotherapy decisions and underscore the value of interdisciplinary ethics consultation in supporting patient-centered, ethically sound care. Early goals-of-care discussions and proactive clarification of decision-making authority may mitigate conflict and reduce ethically challenging scenarios.