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1 6 9 F r o n t S t r e e t S o u t h , O r i l l i a , O N , L 3 V 4 S 8
Phone: 705.325.0505 Fax: 705.325.7328 www.nsmhpcn.ca
Expert Panel Discussion:Integrated Care
– Where Do We Turn?
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: NoneConsulting Fees: None
Other: None
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)
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 1, continued:
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 Y, 82 years old
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 2: Mrs R – 69 years old female
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
Case 3: Mrs K – 36 years old
A big thank you to all of our expert panel members.
