Communication Issues in Palliative Care: A Case Study

Running head: CASE STUDY
Case study
Name of the student:
Name of the University:
Author’s note

1CASE STUDY
Introduction:
Effective communication plays an important role in palliative care or end of life as it
helps to engage in advanced care planning and achieve positive outcomes related to quality of
life, high satisfaction with care, low level of stress and anxiety for bereaved family members
and reduction in health care (Adams, Mannix and Harrington 2017). However, challenges in
palliative care arise as most patient’s lack the capacity to take decisions on plan of care. This
report aims to identify such communication issues at the end of life by watching the video of
Tom, a 55 year old man with advanced lung cancer and multiple metastases. The video will
process Tom’s information to identify the issues, establish goal of care and appropriate
course of action to promote health and well being for
Identify the issue:
Based on the review of Tom’s story, it has been found that Tom was admitted to the
hospital by his wife, Cec and his son, Jimmy after falling in the bathroom. On assessment by
nurse Sarah, Tom was found to be in pain and had breathing difficulty. Nancy is the
Aboriginal liaison officer and on Nancy’s communication with Tom’s family, it has been
found that Tom was not willing to use morphine medication as her Aunt Joyce died because
of consuming the medication as she was drowsy after taking. Hence, from this information, it
can be inferred that poor experience of his aunty Joyce has made Tom cautious about the
medication. Another clue coming up from the communication was that the family relied on
their traditional healer, Uncle Joe to take any care decisions. This information suggests that
maintaining patient’s preference related to use of morphine was critical to promote safety of
patient. This was necessary as part of ethical principles of autonomy at end of life care as it
involved preserving patient’s right to self decision even when the patient has lost decisions
capacity. It also mentions giving priority to autonomy instead of paternalism even when the

2CASE STUDY
patient’s best interest is not served due to patient decision (Johnson et al. 2018). However,
how far the patient’s apprehension and fear of drug has been addressed to promote use of
drug is not clear.
In addition, the review of current condition of Tom also shows certain challenges or
limitations in palliative care communication. For example, after deterioration of Tom’s
condition, Carina had expressed her anger and revealed that she has the power of attorney to
take decisions on behalf of his father and stop morphine medication. However, Jimmy
confirmed that Cec is the guardian for Tom. Hence, the key ethical issue arising in the case
scenario is the conflict in relation to power of attorney for taking decisions for patients at the
end of life and violation of legal aspects in relation to advanced care planning. This is said
because Carina has confirmed that she has the power attorney to take decisions for her father.
In this scenario, ethical conflict is seen in relation to advanced care planning, patient
autonomy and decision capacity. The health care staffs did not communicated about advance
care planning details for Tom to minimize distress level and conflict for his family. However,
as Tom did some advanced care planning with his GP, it was necessary to communicate the
same to their family. According to the ethical principle of end of life care, advanced
directives during advanced care planning should be clearly documented in patient’s medical
record and all treatment should take place accordingly. It should include all elements like
pain management, rejection of treatment and location of treatment (Sinuff et al. 2015).
However, such details for Tom were missing in medical record. It only had statement related
to NFR (No further resuscitation). The goal of advanced care planning is to maintain peace of
mind for the patient (Thomas, Lobo and Detering 2017). However, this was not achieved in
the context of Tom. Lack of clarity regarding patient’s preference is one of the pitfalls of
advanced care planning. For this reason, conflict took place between care provider and the
family.