Transcript An Integrated Approach Palliative Care in North Simcoe Muskoka

2014 Palliative Care Conference, Huntsville
Faculty/Presenter Disclosure: Panel Presentation
Presenters:
Kelly Hubbard, Dr. Pam McDermott, Maureen O’Connell, Amy Pritzker, Dr. Glenn Robitaille,
Ken Smith, Catherine Wallis-Smith, Rebecca Woodall
Relationships with commercial interests:
Grants/Research Support: None
Speakers Bureau/Honoraria: None
Consulting Fees: None
Other: None
169 Front Street South, Orillia, ON, L3V 4S8
Phone: 705.325.0505
Fax: 705.325.7328
www.nsmhpcn.ca
Case 1: Mr X, 43 years old
 Mr X is 43 years old
 Fiancée, two daughters 8+10, supportive family (mom, dad, sister, friends)
 6 week diagnosis of aggressive ca lung, with mets to brain, liver.
 No treatment offered/provided.
 Admitted to residential hospice care.
Case 1, continued:
 PPS 20%, condition deteriorating quickly. No advanced directives.
 Non verbal, moans and facial grimacing present when repositioned and
when care provided.
 Mr X is described by his family to be “very healthy” Only ate organic food,
ran 5 km /day and never took any chemical medication. He visited a
naturopathic physician regularly (prior to illness).
 Family is devastated. Fiancée suffering from Post Traumatic Stress Disorder
(PTSD)
Case 1, continued:
 Family refuses to allow pain medication to be given “states he has never
taken a chemical drug!”
 Nurses gave morphine subq after ++ health teaching with family; they
agreed for one dose, then refused additional doses.
 Died in pain
Was this in the best interest of the person?
Case 2: Mrs Y, 82 years old
 Mrs Y is 82 years old, one daughter, one son.
 Daughter is SDM.
 In acute care facility
 Treated for CHF, is now stable, history of depression, short periods of
confusion
 PPS 30%, discharge plans to LTC
 Resident “Capable” (as per CCAC) to make placement/discharge decisions.
Suspect of emotional and financial abusive relationship between son and
mother - “elder abuse?”
Case 2: Mrs R – 69 years old female
 Staff encouraging DC to LTC- son insisting DC home.
 Staff “unsettled to discharge plans home”
 Resident refuses to go to LTC. States “wants to go home with son”.
 Discharged home.
 Died two weeks after discharge
Was this in the best interest of the resident?
Case 3: Mrs K – 36 years old
 36 year old female, newly diagnosed breast CA
 History of depression, anxiety and OCD.
 Supportive spouse, two young children 2+3.
 Spouse unable to go to work, on LOA.
 Refuses to have treatment as concerned that she can’t leave her children
at home. Feels she has to look after the children.
 Spouse feels helpless, but feels he needs to respect her decision.
Discuss
A big thank you
to all of our expert panel members.