Friday, February 18, 2005

Your Truth: The Discordant Family Scenario

Back by popular demand – here is a hypothetical situation and I want to hear your opinion on how you might handle it. I’ve had a lot of cases that were along this theme lately. After hearing your thoughts, I will share a little about things I’ve done under these circumstances.

Ms. Ingot is 53-year-old female patient with metastatic breast cancer that has spread to several organs, including the lungs and bones. She has been suffering with severe dyspnea (difficulty breathing) and bone pain along her spine where her metastasize has occurred. Her two adult children (a 31 year old son and 29 year old daughter) and her husband have been very involved in her care.

The medical team has broached the subject of hospice. Ms. Ingot responds with insightful, intelligent questions and seems to be considering this option. She is very tired from the ongoing dyspnea and the recurring pain. And tells you that hospice sounds like a good option if it can help make her more comfortable. She understands that in order to get her pain and dyspnea under control, the medication may make her sleep a lot more. At the present time, with the goal of her care being prolonging her life as long as possible, adequate pain and dyspnea management has not been feasible, as the levels of opioids necessary to make her comfortable may hasten her death some. Understanding the predicament she is in, she is very inquisitive about hospice and the possibility of being made more comfortable is very appealing to her. She communicates all of this rather slowly as with her dyspnea, it is very hard for her to get enough breath to speak in full sentences.

After this discussion, Ms. Ingot’s husband and eldest son, however, have begun to stand vigilantly outside her door. Everyone who tries to enter, they approach with an aggressive demeanor, “You’re not going to talk to her about dying. We won’t have any more of this death talk. My wife/mother doesn’t want to talk to you about hospice anymore.” Their body language is threatening.

What do you do? Here are some ideas to get your thoughts flowing;

-meet with each family member separately to discuss their concerns and try to get them onto thee same page
-meet with the family as a group and simply allow them time to talk without pushing any agendas – for hospice or otherwise
-wait a few days to give them time to sit with the idea of hospice on their own
-drop off educational literature about hospice and agree not to go into the room
-agree not to discuss hospice and just visit and offer support
-spend time in the room and hope that Ms. Ingot initiates the topic of hospice so that you are still respecting the family’s wishes
-meet with Ms. Ingot when the family is not there so she may make the decision and then the family will just have to live with it
-call security to escort you into the room so that Ms. Ingot’s family cannot act out their threats when you discuss hospice with Ms. Ingot again

Once again, I am not proposing any of these are the right answers. I’m just getting the dialogue started. What are your thoughts?

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