Palliative Care: Challenges, Strategies, and Implications for Breast Cancer Patients

This document discusses the challenges faced by breast cancer patients in palliative care, focusing on the uncertainty about the future and the implications of triple-negative breast cancer. It suggests strategies such as the use of care bundles and approaches that focus on communication and education. The document also explores the signs and symptoms of breast cancer, the role of radiation therapy, and the importance of multidisciplinary care teams. It highlights the nursing problems of pain and symptom management, preparation for the end of life, and achieving a sense of completion. Additionally, it discusses short-term goals for patients and self-care strategies for caregivers.

Running Head: PALLIATIVE CARE 1
QUESTIONS AND ANSWERS
Student Name
Institution Affiliation
Date

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Question 1
(a) Choose one of the challenges Michelle faces and discuss in detail why this is a challenge for
Michelle using contemporary literature to support.
Michelle faces the challenge of uncertainty about the future. According to the case
presented, Michelle has been informed by the doctor that her cancer cannot be treated because it
has extended to various parts of her body (Palliative Care Curriculum for Undergraduates).
Derived from her first question when the results were out, Michelle would have confidence if the
situation could be treatable. However, being informed that cancer could only be controlled but
not treated made her broke down in tears because that implied a future she cannot be sure of. She
also has children and the feeling that she may die anytime make her feel uncertain in whatever
she does. This is common with patients suffering from life-limiting illnesses because they cannot
be sure of the day when their conditions will drive them into the grave (Palliative Care
Curriculum for Undergraduates).
(b) Suggest two strategies that may assist Michelle with this particular challenge.
 Use of care bundles: Care bundles are set of interventions which are used together in
order to significantly improve the health conditions of a patient. In this type of care
approach, multidisciplinary teams work together with an aim of delivering the best
possible care to a patient supported by an evidence-based research and other practices.
The ultimate goal for care bundle is to improve the outcome of a patient care. In the case
of Michelle, multidisciplinary teams like Psychiatrists, General practitioners, Physicians,
surgeons and Palliative care consultants.
 Approaches that focus on communicating and educating her on the condition: Michelle
needs moral as well as spiritual support which can be realized from communication and

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being educated on her condition. She is living her last days and getting hope from people
around her will help her stay a little bit longer.
Question 2: Review the anatomy and physiology of breast cancer.
(a) Michelle had triple-negative breast cancer. Describe what this means and the implications for
Michelle.
Having triple-negative breast cancer meant that her breast cancer tested negative for
progesterone receptors, excess HER2 protein and estrogen receptors (Nbcf). This was an
indication that Michelle’s breast cancer growth was not being fueled by estrogen hormones,
progesterone hormones or HER2 protein. Therefore, her breast cancer could not respond to
treatments that target HER2 protein receptors or hormonal therapy medicines which are common
approaches in treating cancer (Nbcf). Since patients with triple-negative breast cancer don’t
benefit from hormonal based therapy due to lack of target receptors, administration of
chemotherapy, surgery or both combined have remained the only available modalities on triple-
negative breast cancer patients.
Question 3: Review and recall your knowledge of cancer and the possible adverse complications
that may occur.
(a)List four possible signs and symptoms of breast cancer that Michelle may have (Breast Cancer
- Symptoms and Signs, 2018).
 Parts of her breasts or whole breasts swelling
 May experience nipple or breast pain
 Her nipples may turn inwards
 Her breast skin appearing red or thickening

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(b)Using your knowledge of anatomy and pathophysiology, explain in detail why one of these
signs and symptoms could occur (Breast Cancer - Symptoms and Signs, 2018).
 Retraction or inversion of nipples is caused by the malignant cell chances behind the
nipple. It is a result of these cell changes that nipples get inverted and reverse inwards
into the breast.
Question 4: Review current information and think about Michelle’s presentation, the
observations that have been carried out and what further assessment you would want to carry out
now.
(a)List one test Michelle has had.
Biopsy test: not necessarily done on breast cancer but in all types of cancer, Biopsy is the
main approach used by doctors to diagnose cancer. In this test, a doctor takes some small amount
of tissue from the affected body part to be examined under a microscope. It is the only test that is
used to make diagnosis while other tests only give a clue of cancer. In this test, a doctor uses
specialized needles guided by X-ray to extract core tissues from the suspicious breast. The
tissues are then analyzed in a laboratory to confirm whether they are cancerous (Breast cancer,
2019).
(b)What was the outcome of this test?
The biopsy samples were analyzed in the laboratory and confirmed that the cells in her breasts
were cancerous (Breast cancer, 2019)
(c)What does this mean for Michelle?
That meant that Michelle had breast cancer. Further, it was confirmed that her breast
cancer was so aggressive and the cancer cells did not have hormone receptors and other receptors
which might have influenced her treatment options (Breast cancer, 2019).

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Question 5: Michelle is undergoing palliative radiation therapy.
(a)Why is Michelle being given radiotherapy?
Radiation therapy is an approach of cancer treatment that mainly uses a concentrated
radiation beam to kill cancerous cells. External beam radiation is the most common type of
radiation therapy. It uses a machine to direct high-energy radiation beams in the affected body
part to kill the cancer cells. Radiation therapy is mainly used to kill cancerous cells and shrink
tumors. Michelle was given radiotherapy to shrink cancer, slow down its growth and control
some of its symptoms (Morrow)
(b)Name two side effects of the radiotherapy for Michelle (Morrow).
Although radiation therapy has proved to be an effective treatment of many types of
cancer, it has its own side effects like any other treatment. The side effects differ from one
person to another and depending on the type of cancer, its location, the radiation dose and the
victims’ general health. According to the case study, Michelle’s cancer is on her chest and hence
radiation therapy is likely to cause:
 Fatigue: Fatigue is the feeling of being exhausted or tired almost at all times. The level of
fatigue however depends on the treatment plan. For instance, when radiation therapy is
combined with chemotherapy, the level of fatigue is high.
 Cough, fever, and fullness of the chest, a condition which is also known as radiation
pneumonitis.
(c)State two strategies to minimize the effects of each stated side effect (Morrow).
 Physical activity: this entails staying active all the time to relieve cancer-related fatigue.
This may entail taking some walk, field exercises and other activities which can be
advised by healthcare teams.

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 Getting enough sleep: this will enable the patient relax and have peace of mind.
Combined with medication like pain killers, the impacts of fever and coughing will have
been minimized.
Question 7: List one sign and symptom that Michelle is currently experiencing
 Breast lump and thickening that is different from other tissues in the breast (Breast
cancer, 2019)
Justify why this is occurring?
This is as a result of abnormal growth of breast cells. The cell division takes place in a
more rapid manner than healthy cells and accumulates to form a lump or the mass (Breast
cancer, 2019). The cells have also metastasized through her breast to lymph nodes and other
body parts.
Question 8: Michelle may have an acute resuscitation plan.
(a)Explain what is meant by this?
An Acute Resuscitation Plan (ARP) is a medical order which is signed by senior most
doctors in a hospital to provide clinical directions in an event of patient’s acute deterioration
(Queensland Health, 2016). It records all resuscitation planning outcomes based on patients will,
or the patients substitute decision makers in case the patient lacks the capacity to communicate,
and other multidisciplinary team members.
Question 9: List the three highest priority relevant nursing problems for Michelle.
 Pain and symptom management
 Preparation for the end of life
 Achieving a sense of completion

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Justify why each of these is a problem
Pain and symptom management is a problem on Michelle because her cancer has reached
to a point where it can’t be treated and hence pain and symptom management will be continuous
(Cirilo, Dias, Silva, Miranda, Moreira & Cirilo). In consideration to the second point, it also
relates to the fact that Michelle’s breast cancer is incurable and hence will keep on taking
medicine to control its severity as she waits for her end days. Lastly, it will be difficult for her to
accept the fact that she is only awaiting her last days because her cancer can’t be alleviated.
Question 10: Write the three most important short-term goals for Michelle in SMART format
(Clinical Evidence)
 Dealing with her breathing problems
 Chemotherapy to control cancer from spreading further
 Manage her condition
Question 11: Michelle may have an advanced health directive.
Explain what this is?
An advanced health directive which is also known as the medical directive is a legal
document which allows a sick person to specify the actions to be taken for their health in cases
where they are able to make decisions on their own because of illness or incapacity (Queensland,
2018).
Question 12: The Nurse asks Michelle if she would be interested in seeing a psychologist for
support. In what circumstances should a referral to a psychologist be considered and what role
does a psychologist play in the management of Michelle and her family?

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Just like doctors are called for to intervene where a person is sick when a patient’s
problem is psychological a psychologist is the right person to intervene. For instance, Michelle is
facing psychological problems after being notified that her breast cancer has gone viral and can
be treated (Wahass, 2005). On the other hand, Michelle has children who after getting
information that their mother’s cancer has become life-limiting will develop psychological
disturbances. The two cases are no longer medical but psychological.
A psychologist will help give Michelle and her family moral support through talk therapy
which equips them with knowledge and information about what Michelle has been diagnosed
with and the implications to the family (Smith, Schwebel, Dunn, & McIver). Any fears which
might have been instilled are also tackled and where possible a solution sought on the
psychological issues affecting them
Question 13: List 4 Multidisciplinary health professionals that might be part of the palliative
care team (Department of Health & Human Services, 2015)
 Psychiatrists.
 General practitioners
 Physicians and surgeons
 Palliative care consultants
Justify one in detail and relate to Michelle
Physicians and surgeons are specialists in specific areas of medicine. There are different
types of physicians like oncologists, neurologists and respiratory physicians (Department of
Health & Human Services, 2015). In the case of Michelle, Oncologists will play a major role in
diagnosing the progress of Michelle’s cancer whereas respiratory physicians will help manage
the respiratory issues which are facing Michelle as a result of his lungs being affected by cancer.

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Question 14: List 4 signs and symptoms that may indicate that Michelle’s short term goals are
being met (I have a life-limiting illness)
 Michelle is still under medication to control her health condition
 Her family members are being engaged by psychologists
 Michelle’s health has been deteriorating slowly but not abrupt
Justify one in detail
Despite the fact that Michelle’s fate is death, medical support has continued to be
administered in order to manage her body health (I have a life-limiting illness). Up to her last
moments, the doctor still promises to administer some medication to control the fluid which is
coming out of her throat.
Question 15: What is a self-care strategy that you might use when caring for people with life-
limiting illnesses?
 Seeking professional counseling (Stress in Pediatric Palliative and Hospice Care)
Justify why this would be good for you.
Considering the fact that the patient in question continues to waste away on your hands
and also with the knowledge that the end results will be dead, this is likely to disturb the
caregiver to an extent of affecting his health status (Stress in Pediatric Palliative and Hospice
Care). For that matter, seeking professional counseling will be more important because it will
help alleviate some of the feelings you might have as a result of the interaction.

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References
Breast Cancer - Symptoms and Signs. (2018, November 19). Retrieved from
https://www.cancer.net/cancer-types/breast-cancer/symptoms-and-signs
Breast cancer. (2019, January 10). Retrieved from https://www.mayoclinic.org/diseases-
conditions/breast-cancer/symptoms-causes/syc-20352470
Breast cancer. (2019, January 10). Retrieved from https://www.mayoclinic.org/diseases-
conditions/breast-cancer/diagnosis-treatment/drc-20352475
Cirilo, Dias, J., Silva, Miranda, M., Moreira & Cirilo (n.d.). NURSING CARE MANAGEMENT
FOR WOMEN WITH BREAST CANCER IN PALLIATIVE CHEMOTHERAPY.
Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-
07072016000300325
Clinical Evidence. (n.d.). Retrieved from
https://www.caresearch.com.au/caresearch/ClinicalPractice/Physical/EndofLifeCare/Prin
ciplesofGoodEndofLifeCare/tabid/739/Default.aspx
Department of Health & Human Services. (2015, September 18). Who's who in a palliative care
team. Retrieved from
https://www.betterhealth.vic.gov.au/health/servicesandsupport/whos-who-in-a-palliative-
care-team
I have a life-limiting illness. (n.d.). Retrieved from https://www.victoriahospice.org/how-we-can-
help-you/i-have-life-limiting-illness

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Morrow, A. (n.d.). Cancer and Comfort Are the Two Sides of Palliative Radiation Therapy.
Retrieved from https://www.verywellhealth.com/palliative-radiation-therapy-1132351
Nbcf. (n.d.). Triple Negative Breast Cancer :: The National Breast Cancer Foundation. Retrieved
from https://www.nationalbreastcancer.org/triple-negative-breast-cancer
Palliative Care Curriculum for Undergraduates. (n.d.). Retrieved from
http://www.pcc4u.org/learning-modules/core-modules/module-2-communication/1-
diagnosis/activity-1-the-challenges-faced/
Queensland Health. (2016, September 12). Queensland Health Acute Resuscitation Plan (ARP).
Retrieved from https://www.health.qld.gov.au/clinical-practice/guidelines-
procedures/patient-safety/end-of-life/resuscitation/overview
Queensland;, C. O. (2018, January 17). Advance health directive | Power of attorney and making
decisions for others. Retrieved from https://www.qld.gov.au/law/legal-mediation-and-
justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-
directive
Smith, Schwebel, Dunn, & McIver. (n.d.). Retrieved from
http://www.psychosocial.com/psr/psr1.html
Stress in Pediatric Palliative and Hospice Care: Causes, Effects, and Coping Strategies. (n.d.).
Retrieved from https://www.nhpco.org/mar-06/stress-pediatric-palliative-and-hospice-
care-causes-effects-and-coping-strategies
Wahass, S. H. (2005). The role of psychologists in health care delivery. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410123/

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