Supporting cancer care clinicians to 'hold' their patients during and beyond the COVID-19 pandemic: a role for reflective ethics discussions

What is known about the role of clinical ethics services in cancer care? A systematic/narrative literature review

The use of clinical ethics services (CES) has been increasing over time, but little is known about the role of CES in cancer care. Cancer diagnosis and treatment are emotionally charged and life-changing experiences, raising existential and ethical questions about the quality and meaning of, living and dying. This narrative review seeks to consolidate the available information regarding how CES are accessed and used in cancer care. The review attempts to answer the question, 'What is known about the role of CES in cancer care?' Papers included in this review were identified through searching PubMed and MEDLINE Ovid; a variety of keywords were used to ensure the capture of all relevant literature. 387 papers were identified using the search strategy, 13 papers were included in the final synthesis following the application of the inclusion and exclusion criteria. Citation searching was conducted. 11 of 13 papers were conducted in the USA, 1 in Germany and 1 in South Korea. A variety of study designs were incorporated into this review. Five key roles of CES in cancer care were identified; conflict resolution/mediation, delivery of ethics education to clinical staff, advising on specific aspects of care, guideline development/resource allocation and emotional support of clinicians. This narrative review outlines how CES can assist clinicians to reflect on, better understand and address, the complex ethical dimensions of their practice. The identified literature demonstrates that early involvement of CES may reduce conflict. More research is needed gathering information from CES directly.

Organisation of cancer care in troubling times: A scoping review of expert guidelines and their implementation during the COVID-19 pandemic

This scoping review mapped the main themes in existing expert guidelines for cancer care issued during the COVID-19 crisis from the period of March 2020-August 2021. The guidelines published during the research period principally relate to the first two waves in Europe and until the beginning of the vaccination campaign. They elaborated recommendations for cancer care reorganisation, in particular triage and quality of care issues. The article highlights the ethical, epistemological, as well as practical reasons that guidelines were not always followed to provide some lessons learned for future crises to enable better guideline development processes. We also elaborate early evidence on the impact of triage decisions and different perspectives on cancer care reorganisation from ethics and social science literature.

COVID-19 recovery: implications for cancer care clinicians

The wellbeing of clinicians delivering cancer care needs to be considered and included in recovery roadmaps from the COVID-19 pandemic. In this paper, we refer to a report undertaken by Cancer Australia to review and reflect on the impact of COVID-19 in the delivery of cancer care. The report focused on post COVID-19 recovery and asked 3 questions: What changed? What has been the impact of that change? And how can high-value changes be embedded or enhanced? We suggest the same three questions should also be asked of cancer care clinicians. Using the three Cancer Australia questions, we draw from clinicians' insights collected through the Victorian COVID-19 Cancer Network (VCCN) and from the wider health professional literature. We summarise key features of the COVID-19 experience for cancer care clinicians, highlighting moral distress, fatigue and disrupted practice. We then discuss how pandemic-related ethical values might guide health leaders and administrators to balance support for clinician wellbeing with ongoing delivery of cancer care for patients.