University Palliative Care Case Study: End-of-Life Considerations

This case study examines the palliative care of Ling Ling, a 65-year-old woman with stage four colon cancer, highlighting the interplay of mindfulness, patient rights, and advanced care planning. The assignment explores Ling Ling's struggles with her illness, family responsibilities, and her desir...Read More

Running head: PALLIATIVE CARE AND END OF LIFE
PALLIATIVE CARE CASE STUDY
Name of the Student
Name of the University
Author note

1PALLIATIVE CARE AND END OF LIFE
Table of Contents
Answer 1..............................................................................................................................2
Answer 2..............................................................................................................................4
Answer 3..............................................................................................................................6
References............................................................................................................................9

2PALLIATIVE CARE AND END OF LIFE
Answer 1
Mindfulness is known as the process that helps a person to maintain consciousness, unite
his thoughts, physical sensations, feelings to generate a positive vibe that affects the surrounding
environment positively. This is a way to accept and pay attention to the thoughts and feelings
without being judgmental. Mindfulness allows people to neglect the rights and wrongs about any
situation and let them sense their real feeling about that moment rather than past or future
(Williams & Kabat-Zinn, 2013). Mindfulness is a useful tool to help people suffering from
chronic and non-curable disorders. Due to their illness and fear to loose social connections,
patients develop stress and hypertension that deteriorates their health condition and pace their
health degradation. Mindfulness in this situation, help them to calm their stress and sense their
real feelings (Goodman & Schorling, 2012). Hence, in healthcare mindfulness is important for
healthcare professionals as well as for stressed patients.
In the case study of Ling Ling (65), she is suffering from colon cancer stage four. She is
been admitted to hospital, however due to her stressful family conditions, she herself diced to be
discharged from the hospital. She has three sons and two of them are suffering from severe
health issues. Her elder and second son are suffering from chronic renal failure and both are on
dialysis. Ling Ling’s husband is works as an odd job worker and does not involve himself in any
household decisions (Ndubisi, 2012). In this case, she is only one to win breads for her family
and take important decisions for them. Ling Ling used to work in the Oncology department of
the hospital she has been admitted after the onset of the disease. She was referred for the
palliative care, which she stared to avail after her pains becomes worst (Burton et al., 2017).

3PALLIATIVE CARE AND END OF LIFE
Due to her depression and stressful health conditions, she should be aware of the concept
of mindfulness to reduce the stress level and the pain she is suffering from. As she was the only
one to take decisions about her family, she become depressed after hearing about her elder and
second son’s health complications. She wanted to be with her family in this adverse condition
and wanted to celebrate the last Chinese New Year by cooking food for her family. These
situations are due to stress, hypertension and due to her high emotional behavior, she was unable
to understand her health complications. Hence, a hospice team was appointed for her to provide
care at her home.
According to the concept, mindfulness has the ability to change her thoughts and calm
her emotional outflow as these two things affected her health adversely. Her vulnerability that
made her discharge herself from the hospital could have been controlled with the concept of
mindfulness. She was suffering from colon cancer; however, she wanted to cook for her family
that describes her priorities in life. She wanted to serve for her family until death and even
wanted to die in her own home with her family members all around. Mindfulness practices could
have helped her to control these emotions. She flowed with all the feelings and emotions of her
life and after the death of her elder-son she broke completely. However, the healthcare workers
used their mindful behavior and let Ling Ling perform all the events she wanted to complete in
her short lifetime without judging her actions.
As Ling Ling was standing at the end of her life, mindfulness was the only way to attain
peaceful and calm death. However, she was bound with all the responsibilities of her home and
she was the only one to take care of her two severely ill son, hence she did not wanted to be
distracted from her family. Hence, she self-discharged herself. Furthermore, if Ling Ling was to

4PALLIATIVE CARE AND END OF LIFE
avail mindfulness practices in her life, she would be advised on all these life incidences of her
own (Aanestad & Jensen, 2016).

5PALLIATIVE CARE AND END OF LIFE
Answer 2
Right of choice is a fundamental preconditions that allows every individual to act with
freedom and allows those individuals with sufficient choices for their conditions. Right of choice
in healthcare allows every individual to avail healthcare of his or her choice without any contract
and decide the intervention, chosen for him or she will be applied or not (Victoor et al., 2012). In
a society, full of biomedical healthcare providers, a huge amount of population has to visit the
doctors they do not trust. This step can affect their health positively as well as negatively. Hence,
right of choice let the people to avail healthcare of their choice and this condition let them
achieve quality healthcare (Lambin et al., 2013).
Right to make decision on the other hand, let the patient decide about the healthcare they
are provided with and take a call about it. The patient in this scenario can decide whether they
want to avail the healthcare intervention provided or prescribed by the physician to him (Blanck
& Martinis, 2015). This right is helpful in the societies where, the patients are not informed
about the treatment they are going through and hence, they are unaware of the consequences
related to it. Furthermore, unawareness about the healthcare affect them adversely and patient’s
health start degrading. Hence, for these conditions, right to make choice help the patients to take
decisions alongside the healthcare professionals for betterment of their own condition
(Schildmann et al., 2013).
Self-determination is a very important concept in the healthcare system that emphasizes
the control of patient in the healthcare strategy created to serve the patient. Older adults are
generally dependent on the public systems and society they are living in. while availing a
healthcare they have to be dependent on the healthcare professional for every medication or

6PALLIATIVE CARE AND END OF LIFE
treatment intervention (Deci & Ryan, 2012). However, self-determination, the ability to decide,
think and making choice can help them to broaden their ability and affect their health positively.
This self-determination process help them to choose action that satisfies their end period of life.
hence, self determination should be a mutual practice where, healthcare professional provide the
patients opportunity to take decisions and the patient should be able to take right choices for
betterment of his own health (Patrick & Williams, 2012).
In this case, study, Ling Ling was provided with all these three rights while attaining
healthcare. After being admitted to hospital, she asked the nurses to finish her life in adverse
conditions as while working in the oncology department of hospital she witnessed the pain and
condition patient’s has to suffer. Hence, she wanted to end her life. When the doctors asked her
to avail the palliative care to treat her adverse pain and stress, she refused at first. The doctors
could have forces her to the treatment procedure as she was unaware of the process. But the
doctor explains all the process and positive consequences of the process to her and convinced her
to undergo palliative care treatment.
The healthcare team also provided her with the right of decision-making and self-
determination during her treatment. When she get to know that her elder son’s health condition
id critical and he is undergoing surgery, she became furious to go to her home. She wanted to
spend the last few days of her life in her won house with her children and husband. She wanted
to celebrate the Chinese New Year by cooking food for her children. These wishes gave her
satisfaction and she wanted to achieve this before her last breath. She made choices for herself
and the doctors gave her the choice hence, right of decision-making was given to her.

7PALLIATIVE CARE AND END OF LIFE
However, these rights and tools become burden for the healthcare team to provide Ling
Ling with quality healthcare. When she self-discharged herself from the oncology department,
she was not in a condition to walk. However, just to fulfill her duties towards her family she
discharged herself from the hospital. Furthermore, one more burden came into existence when
Ling Ling refuses to undergo the palliative care at her home. She was unable to understand that
palliative care has the ability to improve her condition (Lokkerbol et al., 2014). However, after
discussing about the consequences, she agreed to the treatment. A team of social worker and
healthcare hospice was assigned for her treatment at home. However, she refused to take those
treatments to celebrate New Year with her family. Hence, all these situations worked as burdens
for the treatment of Ling Ling’s colon cancer and these burdens were result of different rights
that was given to her in treatment procedure (Hicks et al., 2012).
Answer 3
Advanced care planning is a process to make decisions about the care someone want to
receive if conditions makes him unable to speak for himself. These decisions are personal
decisions regardless of the medical treatment strategies. Advanced treatment care plan includes
personal values, preferences and discussions with the family members (Brinkman-
Stoppelenburg, Rietjens & van der Heide, 2014). In adverse conditions, when the patient is
unable to convey his or her decisions, he or she will use her family members and friends to take
decisions. Advanced healthcare team discusses all these issues with the patient who only has few
months left in their life, to ease the process of healthcare at the end of life conditions (Mack et
al., 2012). I the case study as well, Ling Ling was given the choices to take decisions for her
health. However, her husband was unable to take decisions and Ling Ling was the only one to
decide for her healthcare.

8PALLIATIVE CARE AND END OF LIFE
Perception of death is different for everyone. As the world is divided in several religious
thoughts, concept of death differs from one place to another. Ling Ling was a Chinese woman
and her rituals traditions were very important for her existence. Hence, she decided to celebrate
the Chinese New Year instead of acquiring quality healthcare. She wanted to die in her own
house with her family around and in the advanced care discussion she confessed her wish.
However, this wish was against the Chinese perception of death and according to Chinese
beliefs, death of any person inside home brings bad luck. Hence, her husband decided to admit
her in hospital in her last days (Wright et al., 2014).
According to me, this incident completely contradicted the concept of advanced care
planning, where the patient himself decide about the death. However, Ling Ling’s husband did
not allowed her to fulfill her wish. Her husband was not the breadwinner for the family and
therefore, was not included in any important decision of their house. Ling ling used to perform
all the works and decide every small big decisions for her family. However, after she became
unable to speak for herself, her husband started taking odd decisions and she had to die with her
wish not been completed.
I think the patient should be given the advanced treatment plan early in the life. This
would have enabled them to take decisions from starting of their healthcare intervention.
However, the method of applying advanced care plan before three months of death is not
productive. Patients suffering from acute diseases are unable to communicate in such late
conditions of disease. Hence, they communicate with the help from their family members and
friends. In this situation, if the family members too unable to understand the situation can lead to
disparities the advance care plan. Hence, the patient should be given the opportunity to decide
their end of life situation in the early stages of the treatment, after being admit to the hospital.

9PALLIATIVE CARE AND END OF LIFE
Therefore, if their condition becomes worst and they become unable to communicate with the
doctors, professional will be aware of the decision made by the patient and the patient will be
able to die peacefully (Balboni et al., 2012).
Ling Ling’s last wish to die in her own house cannot become effective, as no one in her
family was aware of her wish. All her children were either suffering from adverse health
conditions or were preparing for jobs. Her husband too were not aware of her death condition
and did not participated in any household decision. Therefore, if the healthcare providers
performed the advanced healthcare plan earlier, she would have able to convey her wish to die in
her own home. Hence, I believe that advanced care plan should be implemented at the time of
admission.

10PALLIATIVE CARE AND END OF LIFE
References
Aanestad, M., & Jensen, T. B. (2016). Collective mindfulness in post-implementation IS
adaptation processes. Information and Organization, 26(1), 13-27.
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., ... &
Balboni, T. A. (2012). Why is spiritual care infrequent at the end of life? Spiritual care
perceptions among patients, nurses, and physicians and the role of training. Journal of
Clinical Oncology, 31(4), 461-467.
Blanck, P., & Martinis, J. G. (2015). “The right to make choices”: The national resource center
for supported decision-making. Inclusion, 3(1), 24-33.
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance
care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-
1025.
Burton, A., Burgess, C., Dean, S., Koutsopoulou, G. Z., & Hugh‐Jones, S. (2017). How effective
are mindfulness‐based interventions for reducing stress among healthcare professionals?
a systematic review and meta‐analysis. Stress and Health, 33(1), 3-13.
Deci, E. L., & Ryan, R. M. (2012). Self-determination theory in health care and its relations to
motivational interviewing: a few comments. International Journal of Behavioral
Nutrition and Physical Activity, 9(1), 24.
Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and
improves well-being among healthcare providers. The International Journal of
Psychiatry in Medicine, 43(2), 119-128.

11PALLIATIVE CARE AND END OF LIFE
Hicks, E., Sims-Gould, J., Byrne, K., Khan, K. M., & Stolee, P. (2012). “She was a little bit
unrealistic”: Choice in healthcare decision making for older people. Journal of Aging
Studies, 26(2), 140-148.
Lambin, P., Roelofs, E., Reymen, B., Velazquez, E. R., Buijsen, J., Zegers, C. M., ... & Marshall,
M. S. (2013). Rapid Learning health care in oncology’–An approach towards decision
support systems enabling customised radiotherapy. Radiotherapy and Oncology, 109(1),
159-164.
Lokkerbol, J., Adema, D., Cuijpers, P., Reynolds, C. F., Schulz, R., Weehuizen, R., & Smit, F.
(2014). Improving the cost-effectiveness of a healthcare system for depressive disorders
by implementing telemedicine: a health economic modeling study. The American
Journal of Geriatric Psychiatry, 22(3), 253-262.
Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., ... & Weeks,
J. C. (2012). End-of-Life Care Discussions Among Patients With Advanced CancerA
Cohort Study. Annals of internal medicine, 156(3), 204-210.
Ndubisi, N. O. (2012). Mindfulness, reliability, pre-emptive conflict handling, customer
orientation and outcomes in Malaysia's healthcare sector. Journal of Business
Research, 65(4), 537-546.
Patrick, H., & Williams, G. C. (2012). Self-determination theory: its application to health
behavior and complementarity with motivational interviewing. International Journal of
behavioral nutrition and physical Activity, 9(1), 18.

12PALLIATIVE CARE AND END OF LIFE
Schildmann, J., Ritter, P., Salloch, S., Uhl, W., & Vollmann, J. (2013). ‘One also needs a bit of
trust in the doctor…’: a qualitative interview study with pancreatic cancer patients about
their perceptions and views on information and treatment decision-making. Annals of
Oncology, 24(9), 2444-2449.
Victoor, A., Delnoij, D. M., Friele, R. D., & Rademakers, J. J. (2012). Determinants of patient
choice of healthcare providers: a scoping review. BMC health services research, 12(1),
272.
Williams, J. M. G., & Kabat-Zinn, J. (Eds.). (2013). Mindfulness: Diverse perspectives on its
meaning, origins and applications. Routledge.
Wright, A. A., Zhang, B., Keating, N. L., Weeks, J. C., & Prigerson, H. G. (2014). Associations
between palliative chemotherapy and adult cancer patients’ end of life care and place of
death: prospective cohort study. BMJ, 348, g1219.