Presentation on theme: "Case Discussions Challenges in End of Life Care 15/11/14 MRS J."— Presentation transcript:
Case Discussions Challenges in End of Life Care 15/11/14 MRS J
Age 77 - lives with husband who has dementia. 3 daughters, 2 are local PMH Colorectal cancer + colostomy 4 yrs– Few months ago diagnosed liver mets Type 2 Diabetes, Hypertension
Usual GP on leave so you are doing weekly Wednesday home visit Mrs J c/o mild nausea and occ colicky pain Spending more time in bed Syringe driver in place Taking very little orally Carers and DNs visit daily
Home visit contd O/E comfortable in bed, not in pain but taking only small amounts orally 2 local daughters stay alternate nights 3 rd daughter coming from London at W/E Has DNACPR and has told usual GP that preferred place of care = home.
Friday Afternoon phone call From daughter- distressed. Has come from down South. Very anxious: Mum not drinking…… Asking you to admit her or put drip up at home.
Home Visit to Mrs J Deteriorated Now bed bound – DNS will catheterise her now Drowsy/drifting off…. but able to say she wants to stay at home Husband not able to engage 2 daughters there, - anxious. London daughter insists on a drip. Other local daughter not so sure
Discussion Patient unable to have meaningful discussion Difficulties of diagnosing dying….. Are blood tests indicated? Patient best interests? Benefits v burdens of courses of action. COMMUNICATION