Patients, Families, & Their Physicians
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Case #1
A 62-year-old retired school teacher was diagnosed with pancreatic cancer 18 months ago. Chemotherapy is effective in keeping the cancer from growing. She was recently hospitalized for side effects from the treatment and her physician is proactively addressing the symptoms. She understands that her illness is terminal and her goal is to fight it for as long as possible.
Challenge
She wants to continue treatment and live longer, but is having difficulty living with the side effects. She has communicated to her husband and doctor that she doesn’t want to be on life support if she is not awake and cannot interact with her family, but has not thought about other decisions she may be faced with as she deals with her illness.
She also wants to be in the comfort of her own home but doesn’t want to be a burden to her family.
Solution
The Vital Decisions counselor provided the patient with ways to discuss her concerns about side effects and quality of life with her doctor as she undergoes treatment. The physician has since lowered the dosage of the chemotherapy to continue to manage her disease and ease her side effects.
The counselor helped the patient understand her own healthcare preferences under different circumstances and suggested ways to discuss these with her husband.
It was a difficult conversation to have but she feels relieved that she eased his burden a little and he is better prepared if a crisis were to occur. The patient has not yet been able to have a discussion with her husband about the use of home or in-patient hospice during the end phase of her illness. She knows that she will when she is emotionally ready to face it.
Vital Decisions Consultation
In conversations with a Vital Decisions counselor, the patient discussed balancing the desire to live longer with the effects of the chemotherapy. “It’s a good day when I can do the little things around the house, like water my plants.” She doesn’t want to stop treatment at this time but does not want to be bedridden from the side effects either. The counselor helped her think through the pros and cons of the chemotherapy and provided suggestions on how to talk to her doctor about her concerns.
The patient did put some measures in place to plan for the future. She completed an advance directive appointing her husband as healthcare representative and he understands that she does not want life support measures used if she was unable to recover and interact with her family. The Vital Decisions counselor helped the patient explore possible what if scenarios she may experience as her condition worsens and the patient realized that there were many things she hadn’t thought about. What if her symptoms and side effects prevented her from eating and the doctor suggested a feeding tube? Would she consider this type of life support measure and for how long? She wasn’t sure. It would depend.
What if she was too ill to make that decision if the time came and her husband had to make if for her? He didn’t know what her decision would depend on. The counselor provided her with worksheets and decision aids to help her discuss these topics with her husband and doctor. The patient admitted that she thinks about being an emotional and physical burden on her family at the end. She has not discussed these specific concerns with them. When she is home by herself, she toys with the idea of hospice at home or in-patient.
She wants to be home, but is that going to be too much for her family to bear? The counselor provided her with information about the two types of hospices, the types of services offered with each, and suggested she discuss her fears with her husband. What would he be able to handle and what would be too much for him?
Close details
She wants to continue treatment and live longer, but is having difficulty living with the side effects. She has communicated to her husband and doctor that she doesn’t want to be on life support if she is not awake and cannot interact with her family, but has not thought about other decisions she may be faced with as she deals with her illness.
She also wants to be in the comfort of her own home but doesn’t want to be a burden to her family.
Solution
The Vital Decisions counselor provided the patient with ways to discuss her concerns about side effects and quality of life with her doctor as she undergoes treatment. The physician has since lowered the dosage of the chemotherapy to continue to manage her disease and ease her side effects.
The counselor helped the patient understand her own healthcare preferences under different circumstances and suggested ways to discuss these with her husband.
It was a difficult conversation to have but she feels relieved that she eased his burden a little and he is better prepared if a crisis were to occur. The patient has not yet been able to have a discussion with her husband about the use of home or in-patient hospice during the end phase of her illness. She knows that she will when she is emotionally ready to face it.
Vital Decisions Consultation
In conversations with a Vital Decisions counselor, the patient discussed balancing the desire to live longer with the effects of the chemotherapy. “It’s a good day when I can do the little things around the house, like water my plants.” She doesn’t want to stop treatment at this time but does not want to be bedridden from the side effects either. The counselor helped her think through the pros and cons of the chemotherapy and provided suggestions on how to talk to her doctor about her concerns.
The patient did put some measures in place to plan for the future. She completed an advance directive appointing her husband as healthcare representative and he understands that she does not want life support measures used if she was unable to recover and interact with her family. The Vital Decisions counselor helped the patient explore possible what if scenarios she may experience as her condition worsens and the patient realized that there were many things she hadn’t thought about. What if her symptoms and side effects prevented her from eating and the doctor suggested a feeding tube? Would she consider this type of life support measure and for how long? She wasn’t sure. It would depend.
What if she was too ill to make that decision if the time came and her husband had to make if for her? He didn’t know what her decision would depend on. The counselor provided her with worksheets and decision aids to help her discuss these topics with her husband and doctor. The patient admitted that she thinks about being an emotional and physical burden on her family at the end. She has not discussed these specific concerns with them. When she is home by herself, she toys with the idea of hospice at home or in-patient.
She wants to be home, but is that going to be too much for her family to bear? The counselor provided her with information about the two types of hospices, the types of services offered with each, and suggested she discuss her fears with her husband. What would he be able to handle and what would be too much for him?
Close details
Case #2
A 53-year-old father was diagnosed recently with metastatic liver cancer. He began chemotherapy treatment to shrink the tumors with the hope of having radiation and/or surgery in the future. Cure is not possible and the goal of care is to keep the disease under control. He is at home and is experiencing fever, diarrhea, and extreme weakness.Challenge
The patient and his wife are still in shock over the diagnosis and are overwhelmed. The patient has not reported his symptoms/side effects to his physicians. He fears he will be readmitted to the hospital. The patient will not discuss his illness or his future with his wife. He does not want to know what lies ahead.
Solutions
The Vital Decisions counselor helped the patient identify the priorities in his life as impacted by his illness (respect, dignity, independence, not being a financial burden to his family). She provided the patient and his wife with questions to ask the physician to gain a better understanding of his diagnosis and prognosis. They discussed the benefits of knowing what may lie ahead versus not knowing.
The counselor helped the patient understand that he could communicate to his doctors his desire to remain out of the hospital while better controlling his symptoms. They discussed how explaining his priorities to his physician would help make sure his care plan continued to match his preferences for being at home and retaining some dignity and independence.
Together the patient, his wife, and the counselor created a plan of next steps to ease the feeling of being overwhelmed and help the patient regain control of his medical choices and how he will live his life while dealing with his disease.
Vital Decisions Consultation
In conversations with a Vital Decisions counselor, the patient stated that he is tolerating the chemotherapy fairly well. His wife, however, reported that he is very weak and has fever and diarrhea. She explained to the counselor that he is not reporting his symptoms to the doctor because he doesn’t want to go back to the hospital. He is a proud man who does not want to be a burden to his family. The patient indicated to the counselor that his greatest fear is being incapacitated and requiring help to take care of himself.
The patient has closed down in recent weeks, not talking to anyone about his illness. The couple’s 15-year-old son is very angry and will not discuss anything with his father. The wife is working to provide some income to the family, is overwhelmed with caring for the patient and their son, and feels helpless. The patient admitted that he does not want to think about the future. He said that the chemotherapy has been helping to shrink the tumor and that is what he is dealing with now.
The counselor discussed the benefits of thinking through possible scenarios for how this may go and that developing a plan for the future could ease the decision making burden on his wife. They also discussed how thinking about this now would enable him to remain in control and have many more options available to him than if decisions were made during a crisis.
Close details
The patient and his wife are still in shock over the diagnosis and are overwhelmed. The patient has not reported his symptoms/side effects to his physicians. He fears he will be readmitted to the hospital. The patient will not discuss his illness or his future with his wife. He does not want to know what lies ahead.
Solutions
The Vital Decisions counselor helped the patient identify the priorities in his life as impacted by his illness (respect, dignity, independence, not being a financial burden to his family). She provided the patient and his wife with questions to ask the physician to gain a better understanding of his diagnosis and prognosis. They discussed the benefits of knowing what may lie ahead versus not knowing.
The counselor helped the patient understand that he could communicate to his doctors his desire to remain out of the hospital while better controlling his symptoms. They discussed how explaining his priorities to his physician would help make sure his care plan continued to match his preferences for being at home and retaining some dignity and independence.
Together the patient, his wife, and the counselor created a plan of next steps to ease the feeling of being overwhelmed and help the patient regain control of his medical choices and how he will live his life while dealing with his disease.
Vital Decisions Consultation
In conversations with a Vital Decisions counselor, the patient stated that he is tolerating the chemotherapy fairly well. His wife, however, reported that he is very weak and has fever and diarrhea. She explained to the counselor that he is not reporting his symptoms to the doctor because he doesn’t want to go back to the hospital. He is a proud man who does not want to be a burden to his family. The patient indicated to the counselor that his greatest fear is being incapacitated and requiring help to take care of himself.
The patient has closed down in recent weeks, not talking to anyone about his illness. The couple’s 15-year-old son is very angry and will not discuss anything with his father. The wife is working to provide some income to the family, is overwhelmed with caring for the patient and their son, and feels helpless. The patient admitted that he does not want to think about the future. He said that the chemotherapy has been helping to shrink the tumor and that is what he is dealing with now.
The counselor discussed the benefits of thinking through possible scenarios for how this may go and that developing a plan for the future could ease the decision making burden on his wife. They also discussed how thinking about this now would enable him to remain in control and have many more options available to him than if decisions were made during a crisis.
Close details