Annie, 89 years old, was diagnosed with lung cancer recently. She was taken cared by her daughter Emma at home. Due to her age and health status, Annie’s doctor had advised for no active treatment to be commenced: Palliative Care Essay, NP

CASE SCENARIO

Annie, 89 years old, was diagnosed with lung cancer recently. She was taken cared by her daughter Emma at home. Due to her age and health status, Annie’s doctor had advised for no active treatment to be commenced. A family conference has been planned to discuss further Annie’s care management.

[Scene: A cozy living room with warm lighting. The healthcare team enters are seated together. A knock on the door signals the arrival of the patient and her daughter for the family conference, accompanied by the nurse.]

Palliative Doctor: Good afternoon, Annie, Emma. I am Doctor Beatrice. Thank you for having my team and I. How are you both feeling?

Annie: I’m good.
Palliative Doctor: How are you, Emma? Today we are here for a family conference. And let me introduce the team to both of you. With us we have Ms Rohaiza, she is my senior staff nurse. Ms Siva, our pharmacist. Ms Thurga, our social worker, and Mr. Desmond our spiritual counsellor.

Emma: Thank you so much everybody for being here. I would like to learn how to best support my mother.

Palliative Doctor: So, before we proceed with our conference, I want to inform you some very important information.

Annie, after reviewing your medical history and your CT scan, X-rays, and your blood tests, we have diagnosed you with lung cancer. The image test that we do that we did show that there are cancerous growths in your lung tissue.

Annie: I see. That’s a lot to process, Doctor.

Palliative Doctor: I understand Annie. Receiving a cancer diagnosis is definitely very overwhelming and it’s normal. And it’s normal to have a range of emotions. Please know that we are here to support you every step of the way, ok.

Nurse: Annie, Emma, want to assure you that the team here is looking at the best possible care for you. We are committed to develop a personalized plan of care for you and to address whatever needs and preferences that you may have.

Annie: Thank you, nurse.

Emma: I appreciate knowing that all of you here are going to help us through it.

Nurse: We wanted to know that your well-being is the center of everything that we do here. Don’t worry, we will navigate together to come up with a comprehensive care and support you throughout your whole journey.

Palliative Doctor: So, Annie, let me explain what will happen. We’ll discuss the treatment options with you, including the benefits, potential benefits, and the risks of each different treatment or approach. We will explore how palliative care can help manage and improve your quality of life throughout this journey.

Annie: That means a lot to me, Doctor. It’s comforting to know that I have people I can rely on to help me get along. Thank you.

Social Worker: Annie, Emma. It’s important to recognize that a new diagnosis can bring about a range of emotions. Whether it’s fear, uncertainty or sadness, your feelings are valid. We are here to lend our listening here and shoulder to lean on.

Annie: Thank you. I must admit, I am feeling a bit scared now. I’m not sure what to come, what to expect, but having you all and my daughter here to support me make me feel more at this. Thank you so much.

Spiritual Counsellor: Annie, in times of uncertainty it’s natural for you to seek solace and also comfort from your spiritual practices and also your faith. Whatever your spiritual faith or practices may be, we are here to support you and to ensure that this journey is as comfortable and also you are able to find meaning from this challenging times.

Annie: Thank you. My faith has always been a good source of strength for me. And I am grateful to have your support and God support I lean it even more now. Thank you so much.

Pharmacist: Annie, I would like to emphasize we are here to help to address all the questions and queries needs that you have regards to your medication and treatment options. Now, because we understand it can be very daunting to manage the symptoms and side effects of this. Yeah, so we are here to support and guide you through it all the way.

Emma: That’s reassuring to hear. I know I’ll have a lot of questions as we move forward but knowing that I can rely on you for answers makes me feel more at ease. Thank you. Thank you everyone. Palliative Doctor With that, let’s move forward and with our discussion, we will explore Annie’s current health status. We’ll discuss the different treatment options that are available and outline how palliative care can support you and the family through this difficult journey.

[The family conference continues, with the healthcare team providing information, answering questions, and offering support to Annie and Emma as they come to terms with the new diagnosis and begin to plan for the future.]

Guiding points:
1. Explain what palliative care is.
– Definition
– Different model of care
– Principles palliative care practices
– Palliative care services in Singapore
– How palliative care can add meaning and value to one’s life (physical, psychosocial, and spiritual)

2. Discuss how the team can communicate and break the bad news to the patient and family.
– What is your role as a nurse in breaking bad news?

3. Who should be involved in a family conference?
– identify the rightful healthcare professionals and their roles.
– State the importance of their presence.

4. What are the issues to be included in the discussion/ family conference?
– List out the topics and explain why.
– When would be the best time to initiate an advance care plan.

5. Discuss caregiver support in palliative care services.
– In-patient setting
– Within the community
– Voluntary welfare organisations

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