When family refuses IV pain meds for cancer pt...? - page 8

What do you do when a pt's spouse refuses to allow you to administer IV pain medications as ordered? Pt has end stage cancer w/ brain mets. DNR. Confused most of the time. Has not been deemed... Read More

  1. Visit  GrnTea profile page
    2
    Quote from dishes
    I doubt that no one had a serious conversation with the patient and family about the outcomes. I really believe that when all you've got left is hope, no one should try and take it away from you. If someone loses all hope what do they have left?

    The hospice people will tell you that when we can no longer hope for cure, we can still hope for comfort, for someone to listen, for someone to look after your family after you're gone, for being able to live the days you have left in the best way possible. It is perfectly OK to say those words to patients. I have, and more than once, and it is heartwarming to see how it reassures and calms them and gives them permission to talk about what is important to them in their last days. I recommend it.
    Altra and JBudd like this.
  2. Visit  dishes profile page
    0
    In the situation that Rixter described, the patient had been newly diagnosed with pancreatic cancer within the last two weeks, and even though the chances of survival are slim, the patient was offered and accepted chemotherapy treatment. It sounds like standard practice to me, as the chemo may buy the patient a bit more time. Do you think it would be better to not offer chemo and just offer hospice care in newly diagnosed pancreatic CA patients?
  3. Visit  R!XTER profile page
    1
    Quote from dishes
    In the situation that Rixter described, the patient had been newly diagnosed with pancreatic cancer within the last two weeks, and even though the chances of survival are slim, the patient was offered and accepted chemotherapy treatment. It sounds like standard practice to me, as the chemo may buy the patient a bit more time. Do you think it would be better to not offer chemo and just offer hospice care in newly diagnosed pancreatic CA patients?
    No, not at all. I think all options should be offered and the patient should be the one to choose BUT it all has to be with the proper amount of education regarding realistic outcomes and alternatives I.e. comfort care. Like I said, I don't know what was discussed with them previously, it's possible they were given all realistic options and chose chemo, and if so then I support that. I would never take it upon myself to discuss all that with someone I just met, having no knowledge of what happened previously. at that point I was just trying to control her pain and make her comfortable. But from my observation, it did not seem like they were aware of the gravity of the situation. Again, maybe they were. I don't know for sure. I was just making an observation that I've noticed a lot of cancer patients seem under educated. My ER sees a lot cancer patients and I've noticed this trend. It's possible that they are being educated and instead choose to cling to hope, or possible are in denial, which is fine, I'm not going to get in the way of that.
    dishes likes this.
  4. Visit  dishes profile page
    1
    I understand what you mean about patients seeming under educated when they face of an overwhelming diagnosis. According to adult education theory, an average adult, in a normal learning situation, requires new infromation to be repeated to them at least seven times before they comprehend it. Imagine how many times people who are experiencing the emotional crisis of being given a diagnosis with an extremely poor prognosis need the information repeated.
    BiohazardBetty likes this.
  5. Visit  R!XTER profile page
    0
    Absolutely. I have seen many situations where patients come in, receive overwhelming diagnoses, or families are told overwhelming news about their loved ones, and when we explain to them what's going on often you can see them just blank out while you're talking to them because it's too much to handle. I completely get that. Just this past week I had 3 end stage cancer PTs who came in for pain control. I try to find out what they know about their diagnosis subtly, but I'm meeting them for the first time and the primary concern at the moment is the pain. The ER is also not a realistic place to provide this type of education. It's the responsibility of their oncology team.
  6. Visit  dishes profile page
    0
    I agree R!XTER, there should be a better way for recently diagnosed CA patients to reaccess healthcare then through emerg. What happens when these patients come to your emerg department, are they seen by their oncologist in emerg? or strictly the emerg staff?
  7. Visit  R!XTER profile page
    2
    When they present to the ER its Strictly ER staff, unless they get admitted and their onc team would get involved. With the case I mentioned, the MD just focused on the issue of the moment - the pain, and the multiple serious issues we found on labs - neutropenia, anemia, thrombocytopenia... She was quite sick, and was admitted to MICU. The other patient was also end stage and in her 40's, coming for pain control and it was a different MD on the case. He actually asked her what she knew about her diagnosis, if she was aware it was terminal, if there was family in the picture, etc. I was actually very impressed with his interest in finding out the social aspects as well. I guess a lot depends on the doc.
    dishes and Altra like this.
  8. Visit  rnlately profile page
    1
    My dad was diagnosed with PC in September 2009. He didn't pass until September 2012. Also received chemotherapy and when one treatment would fail; he would switch to another one even tried radiation therapy. He wasn't in denial, he just had a lot of faith and hope. He was well aware as well as the family that the outlook was bleak but in cases like this hope is all you have.
    dishes likes this.
  9. Visit  BiohazardBetty profile page
    0
    Quote from dishes
    Imagine how many times people who are experiencing the emotional crisis of being given a diagnosis with an extremely poor prognosis need the information repeated.
    Amen. It's way too easy to forget this sometimes.
  10. Visit  gcupid profile page
    0
    Quote from DeLanaHarvickWannabe
    And pass the buck to someone else? Niiice...
    It is the "EASIEST" thing to do. When a situation is complex, subjective, and has ethical politics involved, I'd gladly pass it on. Everyone has their limit. I know situations like these would have me to the breaking point. I'd gladly trade a coworker who hates dealing with Trachs&suctioning and/or time-consuming quadriplegics bc it makes him/her sick in the stomach. Nursing is stressful enough. Reassign me to something I can handle. My nerves is shot all ready from the previous two 12 hr shifts I worked. Lets just be happy that I didn't call in and showed up today.

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