Question

semester 1, skills labs week 7, day 1
mr. martin is a 28 - year - old patient with end - stage colon cancer that was diagnosed 1 year ago at stage 4. he has not been accepting hospice services or palliative services up to this point. he went to the dr. initially because he was having symptoms of abdominal pain, blood in the stool, a mixture of constipation, diarrhea, narrowing of stools, and fatigue. this last week he noted his abd. he woke up this morning, getting larger and firmer, and his skin is yellow. he came to the emergency room via private vehicle to see what might be going on with him because this is something new, and he had done all his chemo treatments as advised. (60min)
a. what labs and diagnostic testing do you expect to see ordered? explain the rationale behind your answer.
b. what do you predict is going on with mr. martin?
c. what psychosocial services do you think might need to be implemented or introduced to this patient?
mr. martin is informed that his cancer has advanced to his liver & brain which is a new finding. he knew that he had mets to the peritoneum, lungs, and bones already. you overhear mr. martin telling the md that this is impossible, he had completed all treatments and was told his chances of survival would be great after the treatment. (60min)

1. where do you think the communication breakdown occurred after hearing mr. martin’s response to the news?
2. how can you re - educate mr. martin while supporting his current news? would this need to be approached differently than normal re - education? if so, why & how would you introduce the new information while being sensitive to the current situation?
3. do you think this is a time to re - introduce hospice and palliative care services? is their other resources or people in the care team you could utilize to help?

break (15 min)
oncology informed mr. martin that he will likely have a few days to a week to live. he is now agreeing to utilize hospice services. (30 min)

1. what services does the hospice provide?
2. how can hospice ease the burden on the family and patient?
3. what is hospice’s role in the death and dying process.

discuss research from all the above scenarios & questions and discuss findings and critical thinking in the class. (30 min)
lunch (30 min)
in groups of 3 - 4 students, practice difficult conversations and communication methods surrounding death and dying. write down the dialogue obtained during the role - play scenario.

Explanation:

A. Labs and diagnostic testing: Blood tests (e.g., complete - blood count to check for anemia due to blood loss, liver function tests as there is jaundice suggesting liver involvement), imaging tests like CT scan or MRI to assess the extent of cancer spread including to the liver and brain, and a colonoscopy to evaluate the primary tumor site further. Rationale: Symptoms like blood in stool, jaundice, and new - onset abdominal changes need to be investigated to understand the disease progression.
B. Prediction: The new symptoms of abdominal enlargement, firmness, and jaundice likely indicate cancer progression, possibly with liver metastasis causing the jaundice and local abdominal progression.
C. Psychosocial services: Counseling to help deal with the shock of cancer progression, support groups for patients with terminal illnesses to share experiences, and social work services to assist with practical matters like financial and end - of - life planning.

1. Communication breakdown: Likely, there was a misinterpretation of the prognosis and treatment success. Mr. Martin may have had unrealistic expectations about the cure rate after completing treatment.
2. Re - education: Use empathetic communication, present the new information with clear and simple explanations, and provide visual aids if possible. It may need to be different as he is in a state of shock and denial. Approach with sensitivity, validating his feelings first before presenting the facts.
3. Hospice and palliative care: Yes, it is a good time. Resources like chaplains for spiritual support, home - health aides to assist with daily living, and nurses trained in palliative care can be utilized.
4. Hospice services: Pain and symptom management, emotional and spiritual support, assistance with daily living tasks, and coordination of care.
5. Easing the burden: By managing pain and symptoms, providing emotional support to the family, and handling practical aspects like arranging for equipment and supplies.
6. Role in death and dying: Facilitating a peaceful death, providing emotional and spiritual support to the patient and family during the end - of - life process, and ensuring comfort in the final days.

Answer:

A. Blood tests (e.g., CBC, LFTs), imaging (CT/MRI), colonoscopy. Rationale: Assess anemia, liver function, cancer spread, and primary tumor.
B. Cancer progression with possible liver metastasis and local abdominal progression.
C. Counseling, support groups, social work services.

1. Misinterpretation of prognosis and treatment success.
2. Use empathetic communication, present information simply, approach sensitively.
3. Yes. Resources: chaplains, home - health aides, palliative - care nurses.
4. Pain/symptom management, emotional/spiritual support, daily - living assistance, care coordination.
5. Manage pain/symptoms, provide family support, handle practical aspects.
6. Facilitate peaceful death, provide emotional/spiritual support, ensure comfort.