D400 Task 1 End-of-Life Care Plan Example

End-of-Life Care Planning for a 45-Year-Old Mother With Metastatic Breast Cancer: The Documents That Protect Her Wishes, the Case for Hospice and How to Talk With a Family That Disagrees

Student Name

Leavitt School of Health, Western Governors University

D400: End-of-Life Care, Task 1

Course Instructor

Month Day, Year

End-of-Life Care Planning for a 45-Year-Old Mother With Metastatic Breast Cancer: The Documents That Protect Her Wishes, the Case for Hospice and How to Talk With a Family That Disagrees

The Client and Her Situation

Ms. Tamara Reyes is a composite 45-year-old woman with metastatic breast cancer, with disease in the liver and bones that progressed through three lines of treatment. Her oncologist has told her that further chemotherapy is unlikely to extend her life meaningfully and would probably make her feel worse. She is tired, in pain from bone metastases and losing weight. She tells the clinic's social services worker that she wants to spend the time she has left at home with her children, Diego, 14, and Sofia, 10, and does not want to die in a hospital. Her husband, Luis, wants her to try a clinical trial he found online and says that choosing hospice would mean giving up. Her mother, who lives with them, is a devout Catholic and worries about what the Church teaches regarding stopping treatment. Ms. Reyes has no written advance directive.

This paper explains which end-of-life documents Ms. Reyes should complete and why, how hospice and palliative care could meet her goals, and strategies for communicating with her and her family.

End-of-Life Documents

Two documents matter most. A living will records the treatments a person would and would not want if she cannot speak for herself, such as cardiopulmonary resuscitation, mechanical ventilation or artificial nutrition. A durable power of attorney (DPOA) for health care names a person, often called a health care agent or proxy, to make medical decisions when the person cannot. Many states combine both in a single advance directive form. Because Ms. Reyes has a serious illness, her physician can also complete a portable medical order, called POLST or a similar name in many states, that turns her wishes into orders emergency responders and other clinicians must follow.

These documents make a practical difference. In a national study of older adults who died, about 70% of those who needed decisions made near the end of life had lost the capacity to make them, and those with living wills who asked for limited or comfort care usually received care consistent with their wishes (Silveira et al., 2010). For Ms. Reyes, the most important choice is her agent. If she names Luis, she needs to talk with him about her wishes now, since an agent is expected to decide as the patient would, not as he himself would. If she believes he could not honor her wishes, she may choose someone else, and that is her right.

Hospice and Palliative Care

Palliative care focuses on relieving symptoms and stress at any stage of a serious illness and can be given alongside treatment. Hospice is palliative care for people who have a limited prognosis and have chosen to stop treatment aimed at cure, and it is usually provided at home by a team of a nurse, physician, social worker, chaplain, aide and volunteers. Hospice would give Ms. Reyes what she has said she wants: expert pain control at home, equipment such as a hospital bed, a nurse available by phone at all hours, and support for her children and husband, including bereavement support after her death.

The evidence counters Luis's fear that hospice means giving up. In a randomized trial in patients with metastatic lung cancer, those who received early palliative care had better quality of life, fewer depressive symptoms and were less likely to receive aggressive treatment in their final days, and they lived longer than patients receiving standard care alone (Temel et al., 2010). The trial involved a different cancer, but its message, that attention to comfort does not shorten life, is directly relevant. Ms. Reyes could also start with palliative care while the family considers hospice.

Communication With the Client

Talking about the end of life does not harm patients the way many families fear. Among patients with advanced cancer, those who had end-of-life discussions were not more likely to be depressed or worried, received less aggressive medical care near death and enrolled in hospice earlier; more aggressive care, in turn, was linked to worse quality of life for patients and worse bereavement adjustment for their caregivers (Wright et al., 2008). With Ms. Reyes, the human services professional should begin by asking what she understands about her illness and what matters most to her, then listen more than speak. Open questions, such as "What are you most worried about?" and "What would a good day look like for you now?", let her lead. Her wish to be at home with her children is a clear goal that the plan can be built around.

Communication With a Family That Disagrees

Luis's push for a clinical trial is best understood as grief and love rather than denial to be corrected. A family meeting with the oncologist, the social worker and, if she wishes, a hospice representative gives him the chance to hear the medical facts directly and ask his questions. The social worker can acknowledge his hope, explain that choosing comfort care is not abandoning his wife, and invite him to ask the oncologist whether any trial is realistic for her. The goal is not to win an argument but to help him support her decision.

Her mother's religious concerns deserve respect. A conversation with the family's priest or a hospital chaplain can clarify that Catholic teaching does not require burdensome treatment that offers little benefit, a distinction many families find reassuring. The children need honest, age-appropriate information. Children of 10 and 14 usually sense that something is wrong, and hospice teams include social workers and child life specialists who can help the parents prepare them and involve them in ways they choose.

Cultural and Spiritual Considerations

The family is Mexican American, Spanish is the first language of Ms. Reyes's mother, and family decision-making is valued. Offering a professional interpreter at the family meeting, rather than relying on the children to translate, protects both the mother's understanding and the children. Including the extended family in decisions, while making clear that Ms. Reyes has the final say, balances respect for her culture with respect for her autonomy.

Conclusion

Ms. Reyes has told the people around her what she wants. Completing an advance directive and naming an agent will protect that wish, hospice can make it happen at home, and careful, compassionate communication can help her husband, mother and children stand with her rather than against her.

References

Silveira, M. J., Kim, S. Y. H., & Langa, K. M. (2010). Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine, 362(13), 1211-1218. https://doi.org/10.1056/NEJMsa0907901

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMoa1000678

Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., Mitchell, S. L., Jackson, V. A., Block, S. D., Maciejewski, P. K., & Prigerson, H. G. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 300(14), 1665-1673. https://doi.org/10.1001/jama.300.14.1665