Question

CASE STUDY

Pamela is a patient of Muslim faith, living in Boston MA, with late stage melanoma. She is experiencing a variety of issues that impact her health. When you meet 45 year-old Pamela, she informs you that she is a lesbian and has been in a committed relationship with Elizabeth for 15 years. Pamela and Elizabeth are the primary parents for two children, George who is 20 and Laura who is 18 from Pamela's previous marriage, both whom are living at home with Pam and Elizabeth when they are not in college. Pamela is an owner of a restaurant, very active in her religious community, and enjoyed dancing prior to the onset of her illness. She enjoys walking her Labrador retriever along the Charles River with Elizabeth.

Pamela’s illness has now progressed at a rapid rate and it appears that she is entering into a stage that will require extensive treatment and therapy. Pamela and Elizabeth have discussed together the type of treatment and care that Pamela wants and will agree to. The children strongly disagree with what Pamela and Elizabeth have decided regarding future treatment (to terminate treatment if there is not a positive result within three months and to only receive medication and care that will minimize pain and discomfort in Pamela’s final days.) The children feel that Pamela has been persuaded by Elizabeth to terminate treatment rather than making the decision herself. They do not want Elizabeth to be involved with Pamela's medical care or decisions and are seeking legal help in order to get this accomplished.

It appears that there is not a written medical directive about her wishes and she has not designated her healthcare proxy. Pamela remains aware of the medical issues facing her and appears to be competent to make medical decisions at this time but this could change at any given moment.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma. The team consists of a primary care doctor, an oncology physician assistant, a nurse, a physical therapist, a social worker, an occupational therapist, a recreational therapist, exercise physiologist, dietitian, and a psychologist.

PLEASE ANSWER FOR ALL 3 PROFESSIONALS!

dietitian, a recreational therapist, and an exercise physiologist

1) Describe your educational background for your role, and how your education and training has enabled you to participate in this case.

2) How does your role contribute to the care of the patient?

3) What special concerns you have in your role that you think would affect the patient?

Answer 1

Answer-1 being a Nurse My role in this case

Early stage of melanoma can be successfully treated with surgery , but it is depend on the size and depth of the melanoma and its spread. In Pamela case she is in late stage already progressed so the prognosis rate is very poor. According to American cancer society15-20 percent of people with stage 4 melanoma can live at least for 5 years after diagnosis. Pamela is an educated lady she might aware about it. So it’s her choice to decide whether she wants to continue the treatment or not. We should respect patient’s personal choice.

Answer-2 Cancer treatment causes many side effects including emotional, social and financial.

• Manage the treatment side effect
• Provide psychological support.
• Provide open non judgmental environment
• Allow to express their thoughts and concers
• Easing or relieving pain.
• Inform about disease process and treatment
• Encourage patient to eat high calorie diet
• The caregiver role in cancer treatment is to advocate the patient and their family members not just to treat the cancer.

Answer-3 my special concerns is that involvement of family members including her children about treatment will have positive effects such as reducing distress and anxiety and also it will help to increase her quality of life. Various factors influence our judgments and there are various treatment options of variety of cancer.