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Case Discussions Challenges in End of Life Care 15/11/14 MRS J.

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Presentation on theme: "Case Discussions Challenges in End of Life Care 15/11/14 MRS J."— Presentation transcript:

1 Case Discussions Challenges in End of Life Care 15/11/14 MRS J

2  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

3 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

4 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.

5 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.

6 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

7 WHAT DO YOU DO NOW?

8 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


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