Cancer Registry: Code of Ethics

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Questions and Answers

Within the framework of the NCRA's Professional Practice Code of Ethics, which scenario exemplifies a nuanced ethical conflict related to patient privacy and data utilization, necessitating careful consideration of competing obligations?

  • A registrar routinely shares aggregated, anonymized cancer incidence data with pharmaceutical companies for research purposes without explicit patient consent, adhering to institutional review board (IRB) guidelines.
  • Upon receiving a request from a patient to access their cancer registry data, a registrar discovers inconsistencies between the data in the registry and the information provided by the patient. The registrar unilaterally corrects the registry data to align with the patient's perception, invoking the patient's right to access and control their information.
  • A registrar, bound by state law to report specific cancer cases to a central registry, discovers discrepancies in a patient's medical record that, if corrected, would alter the stage of the cancer and potentially affect treatment options. The registrar delays reporting to allow for further consultation with the treating physician, prioritizing accuracy over timely submission.
  • A registrar participates in a multi-institutional research project aimed at identifying genetic predispositions to cancer. The project requires sharing de-identified patient data across state lines, but the registrar is aware that the receiving institution has less stringent data security protocols. (correct)

Considering the principles of professional conduct outlined in the NCRA's Code of Ethics, under what specific circumstances is a cancer registrar ethically obligated to disclose confidential information without explicit patient consent, while adhering to the minimal necessary standard?

  • When approached by a journalist working on a story about cancer trends in the community, offering aggregate data on cancer incidence rates to promote public awareness.
  • When collaborating with a pharmaceutical company on a clinical trial, sharing patient contact information to facilitate recruitment, after obtaining verbal agreement from the patients.
  • When subpoenaed by a court of law to provide patient data relevant to a criminal investigation, ensuring the disclosure is limited to the specific information requested and the registrar has sought legal counsel. (correct)
  • When requested by a family member seeking information about a patient's prognosis, provided the registrar believes sharing the information would alleviate the family's distress.

A seasoned cancer registrar, deeply involved in association activities, identifies a pattern of data manipulation within a colleague's registry, aimed at inflating performance metrics to secure additional hospital funding. Navigating the NCRA Code of Ethics, what constitutes the MOST ethically sound course of action, balancing loyalty, duty, and the integrity of the profession?

  • Report the observed anomalies directly to the Ethics Committee of the National Cancer Registrars Association, providing detailed documentation and evidence, while maintaining confidentiality to protect the colleague's reputation pending investigation. (correct)
  • Discreetly inform the hospital administrator about the potential data irregularities, emphasizing the need for an internal audit, while avoiding direct accusation to maintain professional relationships.
  • Confront the colleague privately, offering guidance and support to rectify the issues, while emphasizing the importance of ethical conduct, prior to any other action.
  • Attempt to replicate the data manipulation techniques in their own registry to understand the potential systemic issues before escalating the concern, ensuring a comprehensive understanding of the problem.

In which of the following scenarios does a conflict of interest MOST critically undermine the ethical responsibilities of a cancer registrar, potentially compromising the integrity of registry data and patient care?

<p>A registrar owns stock in a medical device company that manufactures equipment used in cancer diagnostics, without disclosing this interest to their employer or when making recommendations about equipment purchases. (C)</p>
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What specific actions must a cancer registrar undertake to ensure adherence to HIPAA's Privacy Rule, Security Rule, and Breach Notification Rule when implementing a new cloud-based registry system for handling Protected Health Information (PHI)?

<p>Utilize a cloud provider certified under ISO 27001, conduct a comprehensive risk assessment, implement technical safeguards such as firewalls and intrusion detection systems, and establish a detailed incident response plan in alignment with NIST cybersecurity frameworks. (B)</p>
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In the context of maintaining professional boundaries and avoiding conflicts of interest, what action represents the MOST ethically questionable behavior for a cancer registrar who also serves as a consultant to a for-profit cancer treatment center?

<p>Recommending the treatment center's services to patients based solely on the center's superior outcomes data, which is derived from a registry dataset the registrar personally manages. (B)</p>
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A junior cancer registrar discovers a senior colleague has been falsifying patient data to improve the registry's performance metrics. The junior registrar is intimidated by the senior colleague's influence within the organization. Applying the principles of ethical conduct, what is the MOST responsible course of action for the junior registrar?

<p>Report the falsification of data to the Ethics Committee of the NCRA, providing detailed documentation and evidence, ensuring the matter is addressed impartially. (B)</p>
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In the context of professional development and lifelong learning, which activity MOST effectively demonstrates a cancer registrar's commitment to advancing the profession and enhancing their own competence, thereby upholding the principles of the NCRA's Code of Ethics?

<p>Independently researching and implementing new data analysis techniques to improve the accuracy of cancer incidence reporting, while sharing findings with the registry community through publications or presentations. (A)</p>
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Considering the NCRA's guidelines on conflict of interest, what specific scenario necessitates the MOST transparent and proactive disclosure from a cancer registrar to their employer and relevant stakeholders?

<p>The registrar is a silent partner in a medical billing company that contracts with the hospital where they are employed, without disclosing this financial interest to their employer. (A)</p>
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How should cancer registrars navigate the complexities inherent in utilizing artificial intelligence (AI) for data abstraction and analysis, while upholding the core ethical tenets enshrined in the NCRA's Professional Practice Code of Ethics?

<p>Cancer registrars should implement continuous human oversight and validation mechanisms with transparent AI, mitigate algorithmic bias, and uphold patient confidentiality. (C)</p>
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Flashcards

Registrar's Ethical Standard

Maintaining high standards of conduct, integrity, and fairness in all professional actions.

Patient Data Confidentiality

Cancer registrars must protect patient's private health information.

Professional Representation

Presenting qualifications, employment and interests accurately.

Conflict of Interest Avoidance

The cancer registrar should avoid situations where personal interests could compromise professional judgement.

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Publication Acknowledgment

Give credit to the original author.

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Duty to employer

Give loyal service and competently carry out your responsibilities.

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Reporting Ethical Violations

Uphold the standards of profession by reporting to the Ethics Committee any breach of the code of ethics by fellow members.

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Regard and Respect

Respecting spaces, opinions, and privacy.

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Study Notes

  • The Professional Practice Code of Ethics was established in 1986, revised in 1995, 2002, 2005, 2008 and 2023.

Preamble

  • Cancer registrars develop and maintain cancer programs in hospitals or centralized locations.
  • These programs cater to the needs of physicians, administrators, and planners.
  • Patient privacy rights are protected.
  • Compliance with ethical and legal standards in health care is maintained.
  • The Code provides definitive guidelines for members of the Association and other registry professionals.

General Guidelines

  • Cancer registrars must conduct themselves to bring honor to the profession and the Association.

Guiding Practices

  • High standards of conduct, integrity, and fairness are to be maintained in all professional actions.
  • Judgments and decisions should be made without personal bias.
  • Primary consideration is to be given to patient health and welfare.
  • Respect and understanding for all individuals, their space, opinions, and privacy should be shown.
  • Violence, harassment, or victimization is unacceptable.
  • Collaboration is necessary to achieve specific outcomes and contribute to the Association's goals.
  • Assigned work should be completed with diligence; incomplete work can cause inequitable situations.
  • Business should be conducted honestly and ethically, avoiding influences and commercialization.
  • Refrain from disparaging the professional work of another member.
  • Workplace "fitness for duty" protocols of an employer or contractor must be followed.
  • Cancer registrars should not work under the influence of alcohol, marijuana, or illegal drugs.
  • Working under the influence of unprescribed Scheduled I or Schedule II medications is prohibited.
  • If Scheduled I or II medications are prescribed, follow a practitioner's instructions.
  • Employers manage drug testing to verify compliance.
  • Performance evaluations should be fair, objective, and adhere to the employer's protocol.
  • Professional titles and degrees should be used with dignity and consistency with the profession.
  • Individuals with an NCRA credential should use the appropriate acronym.
  • Recognize the contributions of fellow members and co-workers to advance cancer registry practice.
  • Publications should give due credit to peers.
  • Speaking out against Association policies is allowed, but misrepresenting personal views as those of the Association is unethical.
  • Confidentiality and the right to privacy in disclosing medical and social information must be upheld.

Confidentiality and Right to Privacy Guidelines

  • Patient information must be kept confidential.
  • The use and release of identifiable/non-identifiable information should follow established institutional policies.
  • Computerization of registry information must protect patient confidentiality.
  • Controls to protect patient privacy when processing information electronically should be established.
  • All applicable employer/regional/state/federal laws must be followed, including adherence to HIPAA.
  • HIPAA includes the Privacy, Security, and Breach Notification Rules.

Cooperation and Support Guidelines

  • Cooperation with other health professions and organizations is important for quality health care.
  • Other health professions need to be respected
  • The medical component must be treated with status, privilege, and authority belonging to their professions
  • Do not make decisions you aren't qualified for
  • Assist the medical staff in programs
  • Courtesy, respect, and cooperation should govern relationships with fellow cancer registrars.
  • Differences in opinion should not lead to actions inconsistent with professional stature.
  • Don't prioritize loyalty over duty by protecting unethical actions
  • Do not discriminate against people

Job Orientation

  • Recognize authority in the cancer registry
  • Discharge duties and responsibilities
  • Give loyal service and carry out responsibilities
  • Complete responsibilities given to them
  • Provide a truthful display of work
  • Assist the medical staff
  • Be courteous to relationships with cancer registry

Guide

  • Support the standards
  • Always uphold the information that would be accurate
  • Shouldn't participate in changes
  • The registrar should retain info that is most accurate
  • Preserve information made by official committees

Guide

  • The registrars shall not discuss things that would violate privacy
  • Disclose to authorities evidence of conduct that has been possible observed
  • Shall exercise discretion

Conflict of Interest (COI)

  • Should avoid conflict

Professionalism

  • Represent accurately
  • Don't misrepresent anything

Guide

  • The achievements and preservation of professional status are accomplished
  • The cancer registrar shall strive to increase the profession's body of systematic knowledge
  • Continue self-improvement

Guide

  • The registrar should participate in developing and strengthen profession

Association

  • Encouraging students
  • The association has a dual responsibility: safeguarding the members of theprofession and promoting the services to be rendered by the professional tothe health field.
  • Transmit al referrals in writing
  • Judgements are the responsibility of the Committee
  • Any finding should be violation

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