End of Life Care Case Study A 78 year old male with Stage III Multiple Myeloma, is accompanied to the clinic today by his daughter, who reports concerns with her father’s steady decline in health, including nausea, loss of appetite, and a marked increase in confusion and difficulty thinking. At today’s visit, the client appears pale, thin, drowsy and uncomfortable. Client reports that his pain has increased to an 8/10 and is present in his back and chest wall. Client reports numbness and tingling in both his arms and legs, with the tendency for them to “give out”. Since his last clinic visit, the client has had multiple falls, with the most recent fall occurring en route to his radiation therapy, which resulted in a 4 day hospitalization for a minor fracture and rehydration. In reviewing the recent hospital notes, there appears to be extensive osteolytic lesions, which are likely the cause of the client’s pain. Recent bloodwork shows a high elevation in his Red Blood Count (RBC), Lactate dehydrogenase (LDH), Beta2-microglobulin (â2M) and a C-reactive protein (CRP), all indicating extensive myeloma disease as well as poor prognosis. Most notably, the client’s Creatinine levels are now elevated, indicating that his kidneys are beginning to fail. Daughter claims she is overwhelmed and distraught at the sudden change in her Father’s illness, claiming she is a single mother of two and a business owner and snaps that she “does not have time to care for him”. The client has 3 other children, however, has not spoken to them in over 30 years. Chart history indicates this estrangement is due to significant family issues revolving around the client’s past alcoholism and aggressive behaviour. Only the youngest daughter, seen here today, speaks with the client and she is the sole POA for Property and Personal Care.

Think… Geriatrics, Inter-professional, Inter-organizational Collaboration (cont.) Client remains capable for decision making and indicates that he wants to die at home, however daughter feels she cannot facilitate this as it is too costly and time-intensive. The client has been dating a fellow building tenant, whom he sought immediate companionship with following his wife’s death 4 years ago. Daughter has voiced concerns to the team Social Worker in the past around the lady friend’s inability to manage her father’s care needs and perhaps most importantly, administering medication. When Social Work initiated referrals to Meals on Wheels, CCAC Community Homemaking, Nursing and Social Work, the client refused entry to the care providers. Daughter is notably upset and states “ You can’t let him die this way!”. Who, Where and Why? Who is responsible? Who should be involved in this client’s care? Why? How will this client’s choices and values be respected? Who will advocate? Should all health care professionals be educated re: Palliative Care? Why? What? What is the goal of care? What factors should be considered re: client’s wishes vs client’s quality of life? What are the existing barriers to good practice? What challenges does this situation pose in working as a team? What would improve inter-agency working? What are the benefits of working as a team in palliative care? What are the challenges you face in your specific discipline related to caring for terminally ill patients?