Gwen is a 64-year-old woman, recently diagnosed with stage IIIC ovarian cancer. She has her first meeting with the medical oncologist today at 10 am. When she hasn’t arrived by 11 am, Tara, the nurse, calls Gwen’s home to check in on her. A man answers the phone, and when Tara asks if Gwen is there, he seems vague and a bit confused as to what she is asking. Abruptly, a female voice breaks in and confirms that she is Gwen. She seems tearful and distressed. She tells Tara that she is unable to keep her appointment because her husband is having a bad day and she just can’t leave him alone.

“My husband has Alzheimer’s-type dementia,” Gwen explains. “He has good days and bad days. My daughter lives close by and can sometimes help, but she had to work today and I just can’t leave him alone in the house. Can I reschedule?”

What Would You Do?

Because high levels of caregiver strain are associated with poor health outcomes for caregivers, including increased risk for depression, cardiovascular disease, and mortality, Tara realizes that coordinating Gwen’s care will be challenging and require a multidisciplinary effort from the whole cancer care team. She tells Gwen that she will call her back in an hour with a plan. She asks for a quick team meeting with social work, the navigator, and the infusion room charge nurse to plan how they will get Gwen the care she needs.

“Nurses provide essential psychological support to patients and families throughout the continuum of cancer care.” In a study by Tariman and Szubski, the authors describe “nurses providing guidance, information and support during end-of-life care, and the importance of nurses listening to patients during periods of decision uncertainties, and supporting patients in extreme distress.”

After discovering that Gwen has signed a release of information for her daughter, Tara works on a plan.

  • Gwen’s appointments will be scheduled for the last time of the day. Her daughter is able to arrange care consistently at this time.
  • The navigator will attend all appointments with Gwen and discuss notes with her daughter later.
  • Social work will arrange for a family meeting to assess Gwen’s husband’s current cognitive situation. Their daughter and her husband will also attend.

Finally, Tara asks Gwen to sign a release of information between her primary care provider, the medical oncologist, and Gwen’s husband’s gerontologist. The three medical professionals need to be kept up to date on the status of both Gwen and her husband. All three need to know immediately if another living situation needs to be arranged.

Tara phones Gwen to share the plan and that she looks forward to seeing Gwen later in the day. Gwen is very grateful, and when she sees Tara that afternoon, she gives her a big hug, saying, ”I’m so glad to be here; thank you for taking care of me.” 

Comments

Posted by Gabriel August… (not verified) 10 months ago

This is a very interesting scenario, although speaking from my experience with family issues interfering with the caregiver/paient's health, almost every single time we're unable to do anything effectively, complex finantial and economical issues seem to limit what our health care team can actually do in order to help these patients.

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