Case Background
A 66-year-old Korean American woman with metastatic breast cancer is hospitalized for severe pain and weakness. Her 39-year-old daughter lives nearby but is not her healthcare agent. The patient has a 42-year-old son abroad, with whom she has minimal contact. Both she and her daughter speak English, though she struggles with medical terms. The patient has decreased mobility, forgetfulness, and difficulty preparing her preferred Korean food. She also has trouble navigating her second-story apartment.
The daughter, who is also working full-time and managing young children, helps as much as possible but is overwhelmed. The patient defers to her daughter’s decisions but privately expresses readiness to die. The treatment team is concerned about her full code status, lack of advance directive, and the family’s unrealistic expectations about her prognosis.
Case Analysis
Patient-family-centered care at the end of life is crucial for patients, families, and physicians since all stakeholders play a role in this case. During this process, it is vital to consider communication with the patient and family. In the given situation, the 66-year-old Korean American patient will be observed. When considering the end-of-life care plan, it is necessary to pay attention to the patient’s and her family’s needs.
Methods to Incorporate Palliative Care
In the given scenario, palliative care is the most optimal choice for the patient, given the woman’s condition of metastatic breast cancer and symptoms. The condition has affected the patient, making it difficult for the woman to complete routine activities.
Pain Management
Regarding the methods of incorporating palliative care, the first involves symptom and pain management (Hugar et al., 2021). In the given case, due to metastasis to the brain and bone, the patient has poor cognitive abilities and low mobility.
Communication
Another method involves communication, and given that the patient understands English, it can be beneficial to communicate information about a woman’s condition to let her know the options and details about her condition.
Strategies to Improve the Quality of Life
The second step in establishing proper care during end-of-life involves strategies to improve the quality of life. The first strategy requires organization philosophy and mission; at this point, it might be beneficial for the patient’s family to decide on early adoption of hospice (Sagha Zadeh et al., 2018). Considering the patient’s lack of communication with her son and her daughter, having full-time and two underage children, it would be best for the patient to have professional help.
Additionally, aside from managing pain and introducing positive patient and family-centered care, it would be best to honor the culture of the patient and cater to women’s needs, including offering Korean meals, which the patient requests.
Ways to Utilize the Strengths-Based Perspective
In the case of strengths-based perspectives, the patient’s care should be based on fostering the patient’s autonomy in daily activities. For instance, previously, the patient could carry out routine instrumental activities of daily living. Now, with the decreased mobility and inability to cook for herself, it is essential to focus on minor activities the patient can perform. For instance, the patient might need to use her phone daily to call her family. Moreover, with the inability to cook meals, the patient might instead make efforts to heat the meals prepared by caregivers in advance.
Cultural Dynamics to Be Addressed
Cultural dynamics that may need to be addressed involve interpreters or minority employee services. For instance, while the patient speaks English, she has difficulty understanding medical terminology, and in such a case, interpreter services can be essential. Moreover, in order to sustain the woman’s connection to her Korean heritage, it can be vital to involve minority employees. In this scenario, if employees have a Korean cultural background, assigning them to this case can be helpful.
Risk-Benefit Analysis
The risk-benefit analysis of cultural, socioeconomic, developmental, and physical factors is additionally vital in this scenario. Among cultural risks are communication barriers, and socioeconomic risks involve housing and the inability of the patient to live safely in a two-story apartment. Moreover, developmental risks involve the deterioration of cognitive abilities, such as retaining information. Finally, the physical risk factor is the low mobility of the patient.
However, the benefits of hospice treatment might cover all of the risks considering the holistic care of symptom management and culturally aware approach from healthcare professionals. Therefore, the risks are eliminated by the benefits of the treatment.
Verbal and Nonverbal Methods of Communication
Verbal and nonverbal methods of communication are necessary for the given patient. Verbal language methods will involve direct oral communication either in English or Korean. This will help communicate with the patient regarding their condition, mood, and other aspects. As for nonverbal communication, it is necessary to concentrate on the tone of voice, facial expressions, body language and pauses between sentences. All of this will help the patient not only feel safe but also help other individuals understand the mood of the woman and see whether she understands what is being said.
Referrals and Community Connections
In the given case, considering that the patient has a small number of family members who care for her, it is also necessary to establish community connections with other individuals. This can be done by attending wellness centers or support groups to communicate with others. As for referrals, these might involve referrals to physicians to assess the patient’s condition, involving their cognitive and physical abilities. Among other recommendations is to assess the permanent home’s safety, paying attention to the ability to move to the bedroom, bathroom, and kitchen without barriers.
Strategies for Successful Care Transitions
Regarding care transitions, it is necessary to pay attention to several strategies. For instance, the first strategy involves managing care and overseeing medication intake since the patient must manage their symptoms and pain. Another strategy involves providing the patient and the family with options and recommendations after discharge. At this point, it is necessary to prepare the family for the next steps in care and the following stages of the condition. Moreover, it will be necessary to make follow-up calls to the family, ask questions regarding the condition, and give additional recommendations.
Four Levels of Hospice Care
Regarding hospice care, several levels are different and must suit the patient’s needs. For instance, the first level is routine home care, based on the care provided to the patient with a stable condition at their home (Medicare, n.d.). Another level involves general inpatient care, which involves the patient in a crisis being cared for by professionals in a facility (Medicare, n.d.). Moreover, continuous home care involves a patient in a crisis, but their symptoms and short-term condition management are at home (Medicare, n.d.). Finally, respite care is based more on the caregiver’s needs rather than the patient’s needs (Medicare, n.d.).
In the given patient’s case, routine home care can initially be considered. Still, with the progression of the condition, inpatient care must be involved due to the progression of the condition and acute symptoms.
Legal Considerations and Ethical Dilemmas
Finally, legal considerations and ethical dilemmas, in this case, involve continuing treatment. From an ethical perspective, one major dilemma might involve the treatment question. While the patient’s family might insist on continuing treatment, it might be futile. From a legal perspective, withdrawal of treatment might be involved. The patient admitted that she is ready to be with God, and in case of signing the DNR, doctors will be legally obliged not to resuscitate the patient. Therefore, the major legal and ethical points involve meeting the patient’s needs and respecting the family.
Conclusion
Hence, the patient’s and her family’s requirements must be considered while developing the end-of-life care plan. Given the woman’s symptoms and her condition, palliative care is the best option for the patient in the present situation. It will be required to contact the family again in the future to check in, ask them about the situation, and offer more advice. Routine home care for the patient in question may initially be considered, but inpatient treatment will be required if the patient’s health worsens. The two most important moral and legal considerations are respecting the family and attending to the patient’s needs.
References
Hugar, L. A., Wulff-Burchfield, E. M., Winzelberg, G. S., Jacobs, B. L., & Davies, B. J. (2021). Incorporating palliative care principles to improve patient care and quality of life in urologic oncology. Nature Reviews Urology, 18(10), 623–635. Web.
Medicare. (n.d.). Hospice levels of care. Web.
Sagha Zadeh, R., Eshelman, P., Setla, J., & Sadatsafavi, H. (2018). Strategies to improve quality of life at the end of life: Interdisciplinary team perspectives. The American Journal of Hospice & Palliative Care, 35(3), 411–416. Web.