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

Running Head: PALLIATIVE CARE 1
QUESTIONS AND ANSWERS
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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).