Question

Scenario

You are a home health nurse who has been seeing P.C., who was diagnosed with small-cell lung cancer approximately 1 year ago. She has been treated with radiation and chemotherapy; however, her provider recently informed her that her cancer is no longer treatable because it has spread to her bones and liver and that the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat bewildered. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn't know what it means.

1. How would you describe palliative treatment?

  CASE STUDY PROGRESS

P.C. confides that she has never formally written down her wishes concerning what types of treatments she would or would not want. You advise her to complete an advance directive and/or living will or to complete a medical durable power of attorney and/or a surrogate decision maker form. In current practice, it is very likely that a part of the home health intake process will be completion of a Physician Orders for Life-Sustaining Treatment (POLST) Paradigm form.

2. What is the purpose of these documents?

3. What health care decisions are considered in these documents?

4. How are advance directives and living wills formalized?

5. P.C. states that she is confused and has mixed feelings about her health care wishes right now.

She asks, “If I fill out this form, can I change my mind down the road?” How should you

answer this question?

6. You inform P.C. that you will help with symptomatic control of her illness. Outline four areas

of care you will focus on.

7. As P.C. becomes frailer and incoherent, how will her treatment be given?

  CASE STUDY OUTCOME

P.C. discusses her wishes with her family and completes the documents describing what she would like her plan of care to be over the remainder of her life span. She passes away peacefully 7 weeks later in her home, supported by her family and friends, under her terms.

Answer 1

Question 1. How wowould you describe palliative treatment?

Palliative treatment is the treatment given to relieve the symptoms and reduce the suffering caused by cancer or other life threatening diseases. Palliative care aims to manage symptoms without trying to cure the disease.

In this case it can be used at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope. Rather, it is about living as fully comfortably as possible. It focuses on providing relief from symptoms, pain and stress.

Question 2. What is the purpose of these documents?

Living wills and other advance directives are written, legal instructions regarding patient's preferences for medical care if he or she  are unable to make decisions for  them.

An advance directive helps loved once and medical personnel to make important decisions during a crisis. Having an advance directive in place ensures that your wishes regarding your health care are carried out, even when you are unable to make decisions. It outlines your wishes about life sustaining medical treatment if you are terminally ill or permanently unconscious.

Question 3. What health care decisions are considered in these documents?

Living wills and other advance directives are written, legal instructions regarding your preferences for medical care of you are unable to make decisions for yourself. It plans ahead and get the medical care you want at the end of life.

Some of the choices you may put in your directive are :

• The person you want to be your health agent and make decisions about their health care for you.
• Your goals , values and preferences about your health care.
• The type of medical treatment you want or don't want.
• Where you would like to receive care
• Instructions about treatments such as artificial nutrition and hydration, CPR and dialysis.
• Donation of organs , tissues and eyes
• Funeral arrangements

Question 4.

Advance directives need to be in writing. Each state has different forms and requirements for creating legal documents.