During Hospice Consultant, Patient states he would like to continue treatment

[DaddyO]

My Uncle was treated for Liver cancer and it has spread to either the pancreas or kidney (i am waiting for the Dr to call me back this morning).

He was admitted to the ER on Sunday and is currently being treated for severe dehydration. He also has ascites and is experiencing discomfort. when i probed to ask will they drain I was told that his primary had put an order in for the Hospice consult. My family does realize that my Uncle has been presented with some challenges so we are not in denial.

but during the consult, he was asked would he like to consider / try other forms of treatment or being admitted into Hospice.

My uncle stated that he would like to continue treatment.

so for starters, and I am not sure how this works, but will we be able to carry out my uncle's wishes. ....or should I ask...how can we carry out his wishes and exhaust his option to continue the treatment.

Thanks in advance.

[traumaRUs, MSN, APRN]

Talk to your Uncles doctors or have him talk to them

We have a hospice bridge program where the pt can receive aggressive treatment but can transition to hospice later if need be.

[heron, ASN, RN]

Agree with above ... it's called palliative care and many hospitals have a palliative care service. The focus is on comfort and quality of life while the pt continues to pursue aggressive or curative care.

I read a report of one study that showed that lung cancer patients receiving good palliative care during treatment actually survived longer. I'll try to find the link and post it, if you want.

[NRSKarenRN, BSN, RN]

Upon hearing that patient wants to continue treatment, one local Hospice calls my agency's Palliative Care program so we can provide education and aggressive symptom management + transition later to Hospice if desired ---some patients choose to stay with our Palliative program until death.

Inquire if this is an option in your area.

[DaddyO]

thanks for all the replies. Greatly appreciated. When my uncle said he was still willing to consider the treatment, I explaiend to my family that we need to exhause his options.

but I don't know what his primary will say. Moreover, should be be speaking more with his oncologist and not the primary dr ?

[heron, ASN, RN]

Speak to both, if only to see who's open to what. I would imagine that the oncologist would be more informed about palliative care ... I've seen it discussed in an oncology journal. They're starting to see how their patients benefit from early palliative care. The primary might not be in a position to make a referral, but speaking with him/her will keep them in the loop ... always a good thing.

[leslie :-D]

thanks for all the replies. Greatly appreciated. When my uncle said he was still willing to consider the treatment, I explaiend to my family that we need to exhause his options.

but I don't know what his primary will say. Moreover, should be be speaking more with his oncologist and not the primary dr ?

for clarification purposes, you don't want your uncle to pursue treatment?

fwiw, tapping fluid can be considered a palliative measure, while on hospice.

as to what dr to talk with, i prefer to go with the pcp, unless s/he indicates otherwise.

in an ideal world, treating a cancer pt, s/b a team effort...

and the oncologist would pass info onto pcp...with pcp being spokesperson.

the way i handle this (when there are too many chefs in kitchen), is if i want my pt to get advocacy, i go to pcp.

but that usually works if PT is the one who talks to his/her own dr.

if you want to oppose pt's wishes, then i honestly don't think it'd make a difference who you speak with.

whoever you decide, please, just collect as much verifiable data to extent possible.

educate yourself, and fight your battle accordingly.:)

leslie

[ErinS, BSN, RN]

I encourage a really frank discussion between your uncle's oncologist and your uncle/family. Ask direct questions such as: What treatment options are left? What are the pros (meaning quality of life improvement or time-lengthening) of treatment and what are the side effects? Would you have your own family member go through the treatment?

A good hospice will provide a wide variety of symptom management, which includes thoracentesis. I often tell me pt's that once you are to a point where you are no longer able to aggressively pursue a cure, let's aggressively pursue quality of life and comfort.

[DaddyO]

Thanks again for all the replies.

Thoracentesis was done on Thursday finally. We asked about this since Monday. His breathing was labored (Stridor) and they sent him for a CAT scan since they believe it was not asthmatic but an obstruction. Nothing abnormal was found and this is when they decided to do the draining.

The family is not comfortable with my Uncle's primary Dr. We are wondering will my Uncle have him as part of his Palliative Care ?

Sidebar: He was admitted into Palliative care and will be coming home on Monday.

[tewdles, RN]

Thanks again for all the replies.

Thoracentesis was done on Thursday finally. We asked about this since Monday. His breathing was labored (Stridor) and they sent him for a CAT scan since they believe it was not asthmatic but an obstruction. Nothing abnormal was found and this is when they decided to do the draining.

The family is not comfortable with my Uncle's primary Dr. We are wondering will my Uncle have him as part of his Palliative Care ?

Sidebar: He was admitted into Palliative care and will be coming home on Monday.

Your uncle should have the option to have the hospice medical director or the pcp as the attending. Most pcps will step away if the pt/family asks to have the hospice med director managing the care.

[DaddyO]

Thanks !

What about Liver or Kidney dialysis. Is this something this is done during Palliative care or would this not be considered a medical necessity ?

I was told last week that my uncle was going thru acute renal failure. Just like the thoracentesis, I asked about dialysis but his primary doesn't seem to want to consider this.

again, my uncle said he would like to fight and this is why i am looking at these other forms of treatment, but it seems like his Primary is thinking one way.

Sidebar:

my uncle was suppose to come home and start palliative care but was getting weak so he is still in the hospital. I stayed with him last night. he slept thru the night but according to the nurse, his organs are shutting down..and this is why I am bringing up the dialysis question.

[leslie :-D]

What about Liver or Kidney dialysis. Is this something this is done during Palliative care or would this not be considered a medical necessity ?

I was told last week that my uncle was going thru acute renal failure. Just like the thoracentesis, I asked about dialysis but his primary doesn't seem to want to consider this.

again, my uncle said he would like to fight and this is why i am looking at these other forms of treatment, but it seems like his Primary is thinking one way.

Sidebar:

my uncle was suppose to come home and start palliative care but was getting weak so he is still in the hospital. I stayed with him last night. he slept thru the night but according to the nurse, his organs are shutting down..and this is why I am bringing up the dialysis question.

if it's true that he has multi-organ system failure, then dialysis would not be helpful, only futile.

and it's certainly not unusual for pts to want to try everything available...it doesn't mean it's always realistic.

denial of terminal disease, is often rampant betw pts, families, and even the physicians involved.

it sounds like someone really needs to present the reality of your uncle's disease process (consistent with other medical opinions), so you can make decisions accordlingly.

leslie