Case study: Janet
2 Spirited: “Two-spirit” refers to a person who identifies as having both a masculine and a
feminine spirit, and is used by some Indigenous people to describe their sexual, gender
and/or spiritual identity.
This case is a good reminder of patient preferences. We need to remain diligent and sensitive
to Janet’s preference of being referred to as “them/they”. I caught myself accidentally referring to
Janet as “she”. The author also made that mistake in the case study.
This section and case has provided information emphasizing the importance of linking indigenous
cancer patients with an Aboriginal Navigator. The focus this week was on emotional, spiritual and
social needs.
Janet :Domain Unique Needs Interventions
Physical 1. pain control
2.Advanced breast cancer: pain,
fungating breast, infected
3. Other physical issues: depression,
diabetes, high cholesterol, and high
blood pressure
4. Smoker: does she want to quit?
5. “feel okay”: assess this further. Is
there hidden meaning in this?
1. Ask Janet if they would want to use the
services of an indigenous navigator to
support them and to liaise with the health
care team members for their care. The
number of team members could be
overwhelming for Janet.
2.ESAS, Pain assessment tools and
Palliative Care referral to provide pain and
symptom management and end of life
supports, as well as supports for other
physical issues: wound care, depression,
diabetes, high cholesterol, and high blood
pressure
Palliative carereferral/toolkit for aboriginal
communities
Dying with dignity?
3. Dietitian referral (diabetes), Social Worker,
Nurse Practitioner/physician to review
medications for cholesterol & hypertension
4.. Assistance with smoking and smoking
withdrawal symptoms if in agreement
informational 1. ask Janet
2. Assess learning style for type of
educational resources to provide
1. Care processes/test results/: work with
indigenous navigator to help bridge the gap
in trust with the health care system. Explain
end of life and how Janet would like to be
supported, assistance with decision making
(via indigenous navigator and palliative care
team, Social Work (SW)
2. Cancer Care Ontario Symptom
management guides on pain:
Emotional 1. depression
2. grief
FIFE model: work with indigenous navigator
Distress thermometer, Canadian Problem

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Janet 2 Spirited: A Case Study

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