Module 6: Communication Case Studies Please Note:

All case studies are intended to be generic so that substitutions can be made, according to your own clinical roles. For example, if a case study mentions a patient with a medical condition, you can substitute the disease cancer, so that it would be appropriate for oncology nurses, or visa-versa. You may also insert APR for nurse practitioners, clinical nurse specialists, etc. !n addition, hospice"palliative care nurses can review each case study, as though they were consulting on each of these case studies. Feel free to ad#ust the case studies so they are relevant to your participant$s clinical practice"needs.

Module 6 Case Study #1 Mr. Jones: Breaking Bad News to Family You have received a hospice referral for Mr. Jones, age 54, who has ALS (amyo rophic la eral sclerosis!. "e and his family (wife and # children$ages %,&', &%!, who are confused and an(ious, lis en o you as you descri)e wha hey should e(pec from he hospice e(perience. *he family does no seem o unders and why you are discussing end+of+life issues wi h hem. You call Mr. Jones, family physician who ells you ha he pa ien assured him ha he al-ed o his family a)ou his prognosis. You de ermine ha Mr. Jones has in fac no old his family. You al- wi h Mr. Jones who admi s ha he has old his family he is very s a)le and e(pec ed o have many years of life remaining. "e as-s you o help him )rea- he reali y of his poor prognosis o his family. .iscussion /ues ions0 &. 1ha is your role now2 3. 1ha communica ion gaps do you recogni4e2 #. 1ha s ra egies would promo e con inui y of care and improve eam communica ion2 4. "ow migh a family mee ing )e helpful in his case2 5. 1ha special needs would you perceive he children having a his ime2 "ow would you mee hese needs2

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Module 6 Case Study # Cindy: !isagreement 8indy is a #'+year old female wi h pancrea ic cancer has )een hospi ali4ed for wo wee-s. She has )een in he in ensive care uni for he pas 5 days. "er physical de eriora ion and suffering had crea ed anguish in her hus)and and in he heal h care eam. *he a ending physician discussed wi h he hus)and he li-elihood of his wife having a cardiac and@or respira ory arres , descri)ed he ac ions he eam would a-e for a full resusci a ion as well as he varying levels of resusci a ion approved )y he rea men se ing, which included a do+no +resusci a e op ion, and as-ed he hus)and o e(press his preferences regarding resusci a ion. *he hus)and ini ially chose he do+no +resusci a e s a us for his wife and comple ed all of official paperwor- o implemen ha decision. .uring he ne( &3 hours, he hus)and ac ively solici ed from nursing and medical s aff heir defini ions of do+no +resusci a e. "e hen con ac ed he a ending physician o rescind his decision, choosing ins ead o have a full resusci a ion order in place. "e e(plained his decision change as, A1hen B saw ha he nurses and doc ors did no all define resusci a ion in he same way, B decided ha B would no leave ha in heir hands. B am my wifeCs hus)and and B will )e her hus)and o he end.A *his new decision was enac ed and over he ne( four days, he pa ien showed clear signs of dying. "er hus)and s ayed wi h her in he in ensive care uni and wi nessed he changes in his wifeCs physical appearance. "e )egan commen ing on hose changes and on his wife,s o)vious suffering. 1i hin wo hours of her dea h, he hus)and old he nurse ha he did no wan his wife o )e resusci a ed. *his informa ion was immedia ely conveyed o he heal h care eam and a )rief discussion wi h he physician, hus)and, and nurse was convened o affirm his decision. .iscussion /ues ions0 &. 1ha were he )arriers o effec ive communica ion in his case2 3. "ow migh hese )arriers have )een elimina ed2

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Module 6 Case Study #" Ma#: Communicating Sudden !eat$ (*his case s udy could )e changed o a pa ien wi h cancer for oncology nurses! Ma( Dlein is an E4+year+old re ired plum)er who has )rough his E#+year+old wife, Mary, o he 6.?. complaining of ches pain. Mary,s condi ion declines, she e(periences cardiac arres and full resusci a ion is a emp ed. .uring his ime Ma( communica es o he social wor-er and chaplain ha A*his Fus can, )e. Mary is heal hy as an o(.A "e doesn, wan o no ify his children who live ou of own Aun il she,s s a)le )ecause B -now hey,ll ge her s raigh ened ou + hey,re really good here a Me hodis "ospi al.A Ma( seems an(ious )u dis rac ed and al-s incessan ly a)ou how Mary,s )een sic- )efore )u Aalways ge s )e er )efore you -now i .A Af er 3 hours of numerous procedures and a emp s, Mary dies. .iscussion /ues ions0 &. 1ha are useful communica ion s ra egies while Mary is s ill receiving aggressive care o communica e her s a us2 3. "ow should Ma( )e old of MaryCs dea h2 #. 1ha is he role of he in erdisciplinary eam in communica ion in his case2

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Module 6 Case Study #% Mr. &uartera 'as ( &uestion Galen4io /uar era is a 5'+year+old man wi h widely me as a ic pros a e cancer. "e is curren ly undergoing radia ion herapy for )one me as asis. "is wife died one year ago from )reas cancer. "e curren ly lives a home wi h his win daugh ers, age &5 years. As you, he radia ion oncology nurse, en er he rea men room, Mr. /uar era as-s you, HSusie, you donC hin- BCm going o die do you2I H1ha would happen o my daugh ers if B die2I .iscussion /ues ions0 &. "ow would you respond2 3. "ow would you address his concern a)ou his daugh ers2 #. 1ha would you recommend ha he discuss wi h his daugh ers a his ime2 4. 1ha o her mem)ers of he heal hcare eam would )e appropria e o con ac o help Mr. /uar era wi h his daugh ers2

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Module 6 Case Study #) Mr. ($med: (cti*e +reatment and Palliati*e Care, Mr. Ahmed is a 4%+year+old wi h a recurren )rain umor curren ly hospi ali4ed af er e(periencing sei4ures. Mr. Ahmed was diagnosed a age 44 and has had e( ensive surgery, chemo herapy, and radia ion herapy. *hree mon hs ago, his oncology eam advised him and his family ha here were no fur her rea men op ions and recommended pallia ive care. *he family was no in eres ed in pallia ive care, hey reJues ed ha Hevery hing )e done.I "e has e(perienced weigh loss, increasing severe headaches, nausea and now sei4ures. Kollowing a severe sei4ure las wee-, his wife )rough him )ac- o he cancer cen er see-ing possi)le new rea men s and wonders if he can receive pallia ive care, oo. As Mr. Ahmed wai s in radiology for a scan, you, he oncology nurse, come o see him as you heard he was in radiology. "e ells you he is so ired of rea men and )eing a-en far away and Fus wishes his family would Hgive up and Fus le me )e a home so B can play wi h my dog and )e wi h my friends.I .iscussion /ues ions0 &. "ow would you respond o Mr. Ahmed2

3. Bs i possi)le for Mr. Ahmed o receive rea men and pallia ive care a he same ime2 Bf so, how would you descri)e his o Mr. and Mrs. Ahmed2 #. "ow could you use a en ive lis ening and presence wi h his pa ien and his wife2 4. ?ole play he scene of how you would respond o Mr. AhmedCs las s a emen . Bn addi ion, role play how you would descri)e pallia ive care o his family. Las ly, role play how you would elici Mr. AhmedCs end+of+life goals (see Kigure &0 6(ercise o 6lici 6nd+of+Life Loals and Kigure 30 /ues ions o As- 9a ien s and Kamilies o 6lici 6nd+of+Life Loals!.

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