Palliative Care Practice: Analyzing Issues in Patient Care Report

This report provides an analysis of palliative care practices, centered on a video case study of a 38-year-old woman diagnosed with triple-negative breast cancer. The report examines the physical and emotional issues faced by patients in palliative care, such as fatigue, breathlessness, pain, emotional distress, and hopelessness. It critiques the holistic perspectives used to maximize the quality of life for patients and their families, particularly focusing on communication of bad news and family-focused interventions. The analysis draws on several academic sources to support its claims, concluding that effective communication and person-oriented care plans are crucial in navigating the complexities of palliative care and improving patient outcomes.

Running head: PALLIATIVE CARE PRACTICE
Palliative Care Practice
Name of the Student
Name of the University
Author Note

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Introduction
The following video analysis of palliative and end of life care is based on the story of
Michelle who is a 38 years old married woman with two kids and was diagnosed with triple
negative breast cancer 2 years ago. The analysis will mainly highlight the issues associated
with palliative and end of life care along with a critique of the holistic perspectives used for
maximizing the quality of life of the patients and their family members.
Discussion
Two issues of palliative care
Physical issue
The main physical issues faced by the patient who are under palliative care include
fatigue, breathless, pain scores and pain skin breakdown (Zimmermann et al, 2014). In case
of Mitchell her main physical issues highlighted in the video is her breathlessness. Mitchell
was reportedly telling that she is facing difficulty in breathing and hence she was unable to
satisfy her professional job role and at the same time, she is unable to drive her children to
school.
Emotional issue
The main emotional issue, which is profound in palliative care, is emotional distress,
depression, anxiety and a sense of hopelessness (Evangelista et al., 2012). In the video,
Mitchell was found telling that she is feeling hopeless, a sense that she never gone through
before. She is losing her job, her children are not spending time with her and she is unable to
satisfy her basic duty towards her children. According to Evangelista et al. (2012), events of

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depression in terminally ill patients are common in 25 to 77% of cases and are associated
with intense sufferings and cause of intense suffering.
Critique of the holistic care
Informing patient about his or her current medical condition has become an art.
Previously it has been the norm to exclude important information and provide patients and
their family members’ false hope or narrate to the concerned family members while keeping
the patient in dark. However, present norms suggest conveying the actual truth to the patient
and their family members (Onyeka, 2010). The first clip of the video shows a lady informing
Mitchell and her husband, the current physical state of Mitchell with no false hopes.
According to Onyeka (2010), breaking the bad news for cancer diagnosis can be debilitating
with far-reaching disturbing consequences like complex clinical outcomes, disequilibrium in
interpersonal and family relationships along with a sense of hopelessness. So in order to
effectively tackle the problem, effective communication skills of the healthcare professional
who is informing the bad news is mandatory. Here the informer has effective communication
skills and the “drooping a bomb” or notifying the bad news was conducted under private and
comfort set-up under the presence of close family member (Mitchell’s husband).
According to Quill and Abernethy (2013), cancer diagnosis affects not just the
patients but also family members generating psychological distress. In addition to this, there
are physical and emotional stress affecting patients and their family members. The
psychological process involved in the disease process can be influenced via family
attachment. However, Mitchell was found reporting that she is gradually becoming detached
from her children and family. However, the holistic care approach as displayed in the video
does not reflected any family focused interventions directed towards the crisis interventions

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along with the promotion of family unity in order to facilitate family relationships. It is the
duty of the healthcare professionals of the multidisciplinary team of palliative care to take
active courses on conflict management in palliative care (Quill & Abernethy, 2013).
According to Puchalsky (2016) spiritual care is an essential domain in palliative care.
However, in the video does not provide any detailed illustrations of the approaches related to
the spiritual assessment under the clinical settings while proposing a way to integrate spiritual
distress under palliative care.
Conclusion
Thus from the above discussion it can be concluded that the palliative care is a
complex care plan which demands sound approach from the healthcare professionals both in
the communication ground and in the domain of latest therapy plan about the disease. The
amalgamation of both the plan helps to improve the quality of life of the patients along with
disease recovery as in case of Mitchell. The video showed that during the course of her
disease prognosis, she had gone through emotional and physical distresses which are two
major issues associated with palliative care and effective person-oriented care plan along with
active interventions from the palliative care team will help to circumvent this distress.

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References
Evangelista, L. S., Lombardo, D., Malik, S., Ballard-Hernandez, J., Motie, M., & Liao, S.
(2012). Examining the effects of an outpatient palliative care consultation on
symptom burden, depression, and quality of life in patients with symptomatic heart
failure. Journal of cardiac failure, 18(12), 894-899.
Onyeka, T. C. (2010). Psychosocial issues in palliative care: A review of five cases. Indian
journal of palliative care, 16(3), 123. doi: 10.4103/0973-1075.73642
Puchalsky, C. (2016). Overview of spirituality in palliative care. UpToDate, jun, 8. Retrieved
from: https://www.uptodate.com/contents/overview-of-spirituality-in-palliative-care
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a
more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.
DOI: 10.1056/NEJMp1215620
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., ... &
Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-
randomised controlled trial. The Lancet, 383(9930), 1721-1730.
https://doi.org/10.1016/S0140-6736(13)62416-2