Case Study: Pastoral Role in Terminal and Chronic Illness Care

This case study explores the pastoral care provided to a 15-year-old boy, John, diagnosed with metastatic osteosarcoma, a terminal illness. The paper details the challenges faced by John, his mother, and the physician, including the emotional and physical toll of the illness, differing views on treatment options, and the mother's previous loss of her husband. The role of the pastor is examined, including the provision of spiritual and emotional support through scripture, prayer, and visitation. The paper analyzes the family system's transitions, theological factors like faith and hope, and pastoral strategies such as scriptural encouragement, prayer, and acts of love and care. Lessons learned emphasize the importance of early medical check-ups, spiritual principles, and pastoral care in helping patients and families cope with the devastating effects of chronic and terminal illnesses, highlighting the critical role of faith and hope in navigating such difficult circumstances. The case study also addresses the ethical considerations regarding end-of-life decisions and the pastor's role in guiding the family through these complex choices. The pastor's strategies included offering comfort, mobilizing the church community for support, and providing emotional, spiritual, and social assistance.

Running head: PASTORAL CARE IN LOSS 1
Case study: Terminal and Chronic Illness
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PASTORAL CARE IN LOSS 2
Introduction
A terminal illness is a disease whereby there is no hope of recovery for the sick person.
The issue of terminal illness and how to tackle them has been a difficult topic over the years. The
suffering the patients undergoes during this period is unbearable. As such, in many countries,
they have implemented different policies to deal with this matter. Some have allowed euthanasia
to be carried out, but only under the consent of the patient. Other nations do not advocate for
ending of life (known as assisted suicide in medical terms) no matter how the pain is intolerable
(Battin, Rhodes, & Silvers, 2015). A terminal disease mainly has been described to have five
phases. The first phase occurs before diagnosis, whereby a person senses and recognizes some
symptoms and signs and, thereby realizing they could have contracted a disease or an illness.
The second phase is the acute period whereby diagnosis is made, and the patient is explained
vividly his/her condition. Then, the chronic phase whereby the patient receives medical
treatment. The recovery phase follows where the patient accepts his/her status and is prepared to
handle the stigma that comes with the social, financial, physical, mental, and religious effects of
their illness (Bovero et al., 2016). This paper discusses a case study concerning terminal and
chronic illness (cancer), the pastoral role that I played in the incidence, and the pastoral strategies
employed.
Terminal and chronic illness case study
The case study involves a 15-year-old boy (John- not real name) who was diagnosed with
metastatic osteosarcoma. Osteosarcoma is a malignant bone cancer with a high chance of
spreading to the lungs (Mialou et al., 2005). Primarily, osteosarcoma affects adolescents from
age 12-18 years. However, there are always variations as in some instances it can occur in
children or adults, though in rare cases. The cure rate of the non-metastatic osteosarcoma is

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usually higher (70%) compared to the metastatic one- less than 20% at the time of diagnosis
(Picci, 2007). Treatment usually involves surgery and chemotherapy based on the recent clinical
research trials.
After John was diagnosed with metastatic osteosarcoma, he was immediately placed
under treatment. However, he did not respond so well to conventional medication and therapy.
Therefore, he was taken through a therapeutic randomized clinical trial for almost a full year.
The standard treatment that he was given involved; postsurgical chemotherapy, limb salvage
surgery, and up-front chemotherapy (Chou Geller, & Gorlick, 2008). He did not respond so well
to these therapies as well and, especially the up-front treatment. And so, he was taken through
another program through randomized trials where he received additional experimental
chemotherapy.
John is remaining only with his mother as he lost his father at a tender age through
prostatic cancer. However, together with his mother, they have a very close relationship, and she
encourages him every day through prayer and positive words. John has been participating
actively in all the treatment conference, and in most cases, he has been tolerating the treatment.
Within the last three months of treatment, however, he struggled too much both emotionally and
physically as the procedure was taking over him (Lee et al., 2015). The end-of-therapy scan
revealed that the tumor still existed in the bone as well as lungs. During this period, John
together with her mother went through the most challenging moments of their life. John was
expressing unexplainable pain (Wolfe et al., 2010) and the thought of him dying and leaving his
mother alone brought tears to his eyes every time. His mother, on the other hand, was
uncontrollable due to fear of losing his son after losing her husband through an almost similar
incidence. So, the mother feels an urge to progress his son’s life through a trial of unproven

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experimental therapy. However, John feels he has been through enough and, therefore, he does
not want this intervention proposed by his mother. He explained to the physician in charge of his
treatment that he should not administer the proposed drug but leave him to die according to how
he wants, chooses, or on his terms (Maryland, 2017). The mother, on the other hand, believes
that John has no right to make any decision, but it barely rests on her. Therefore, she asked the
physician to treat her or otherwise she would take her son to another doctor who would be
willing to treat her. John’s mother attends the church that I Pastor, and as such, I was able to
know everything happening in her life. Also, being the Pastor, I was obliged to offer Pastoral
advice and encouragement through prayers and positive words from time to time.
Analysis of the encounter such as the family system transition
The John case study involves various aspects of the family system such as a history of
loss, relationships, and transitions from one stage to another. The incidence typically involved
few participants such as John’s mother, John, physician, as well as the immediate family. Being
the person supposed to offer pastoral care, it was my duty to identify the problems that arose, the
needs of the participants, and hence provide the necessary help. It’s important to note the close
relationship John had with his mother and, how his death would affect her both emotionally and
physically (Tsai et al., 2016). Since she had lost her husband before, the pain could be
unbearable and, so she required emotional and spiritual support. It was my duty to give her all
the necessary help she required through prayers and frequent visitation. John as well needed all
the support he could get through this hard time and, therefore, moral support was vital to show
him that all hope is not lost (Surbone et al., 2010). During this period, it was a transition era for
them especially for John’s mother, since she had lost her husband and now she was at another
point of losing her son. The physician also was in a state of dilemma as he did not know whether

PASTORAL CARE IN LOSS 5
to listen to John or the mother. However, he was bound to act through the legal principles of
physicians.
Theological factors related to the case study
Spirituality plays a significant role in helping the terminally ill patients. More often than
not it helps improve the emotional state of the individual. Religious or spiritual nourishment is
crucial for chronically and terminally ill patients as it enhances their health by improving their
mental health. These people all they need at such a time as this is hope (Gum & Snyder, 2002).
Hope that tomorrow will be better or better still, there is hope of getting well. In this case,
involving John, the theological factors that stood out are; prayer, scripture, meditation,
spirituality, faith, hope, caring, and love. John’s mother is a member of my church and, therefore,
we were able to click as we shared the same religion and spiritual ideologies and principles. In
such an instance where the involved parties were all suffering, it calls for wisdom so that you can
offer the essential comfort needed. As such, I encouraged John’s mother to stand firm in faith
and hope that God was in control. God knows everything about our situations and He is faithful
to carry us through every turmoil. John, on the other hand, needed to hear more of hope
(Johnson, 2007) and being given a listening ear every time.
Pastoral strategies employed
The pastoral role in dealing with terminally ill patients and those suffering from a chronic
disease is critical in determining the effect of the outcome. For instance, in most cases, a
terminally ill patient usually dies after few months. For chronic illness, the person can only stay
alive for about three months since the disease is not curable. Therefore, as a pastor in charge, I
had to come up with strategies that would help ease the tension and pain in the case scenario.

PASTORAL CARE IN LOSS 6
The first strategy is to major in scriptures as you give them hope. The Bible is the best book that
offers hope, encourages, and strengthen the weak and broken-hearted. So, the best thing was to
encourage John’s mother and John himself to keep reading the Bible every day. The scripture
gives direction even regarding issues to do with the end of life. For instance, some terminally ill
patients prefer to end their lives on their terms to avoid the unending pain as well as protect their
loved ones from trauma and draining them financially. In this case study, John as well had
decided not to take further medication but choose according to his terms how to die. The Bible,
however, is against any form of assisted death, suicide, euthanasia, or mercy killing. As such,
John has no spiritual obligation to decide on how to end his life since the Bible is against any
form of self-determination in matters of human existence.
Prayer and meditation are tools that when employed can have a positive effect. It is
believed that individuals who hold to certain religious beliefs, cope better in such instances as
compared to their counterpart (Vasudevan, 2003). They can accept the situation readily as they
still hope for a cure through the faith they possess. However, it is vital for the person offering
pastoral care not to give these individuals false hope. For instance, if they are hoping and trusting
that God will cure them, and then the cure seems impossible and the patient die eventually, there
is a high chance of such people to become distressed and lose their faith. Therefore, my role was
to let them know that God is sovereign and, therefore, they ought to be prepared for whichever
outcome, but they should remain faithful to prayer and God.
People who are undergoing difficult times are in need of individuals who can show them
love and care. Showing love and caring for such people is the basis of Christian principles
(Balboni et al., 2007). Therefore, I would visit John’s mother and John in the hospital to offer
them the love that they needed more. Also, I was able to mobilize other members of the church

PASTORAL CARE IN LOSS 7
and community and encouraged them to visit the family as well as pray for them. It is crucial to
offer in kind of assistance to these people, may it be, emotional, spiritual, physical, or social
support.
Lessons learned and expectations for the future
Chronic and terminal illness results in unimaginable pain and leaves a lot of suffering to
the family members. John’s case was not different and led to much pain between him and the
mother. It is easy for the patient to lose hope and faith due to their condition just as John was
about to do. However, the pastoral care is very crucial in ensuring such people hold on to hope
and they don’t lose their faith (Kaut, 2002). It is crucial for every person to undergo medical
check-up early enough from time to time. In most instances, people suffering from the chronic
and terminal illness, they realize when it’s too late and at an advanced stage that treatment
becomes ineffective (Rabow & Dibble, 2005). If I encounter such a scenario again, I would still
encourage the parties involved to seek better treatment as they hold to hope still since technology
has improved the field of medicine. It is also vital for people to hold on to spiritual principles so
that they may avoid making decisions that are not right concerning ending of life assisted by the
physicians (Campbell, 2017).
Conclusion
Terminal and chronic illness generate a crisis for the parties involved and the family at
large. It disrupts in a significant way the family equilibrium leaving a depression, pain, and
suffering. John’s case was a devastating situation especially to the mother as she was about to
lose her son. It wasn’t easy for John either as he experienced a lot of pain and the medication he
was taking was not working until he was giving up. However, the pastoral role such as showing

PASTORAL CARE IN LOSS 8
love, encouraging, and offering support through prayer (spiritual), moral, and physical support,
goes a long way in giving new hope to this people. In the future, it is essential for people to
undergo a medical check-up to screen for such terminal diseases such as cancer and HIV/AIDS.
References
Battin, M. P., Rhodes, R., & Silvers, A. (2015). Physician-assisted suicide: expanding the
debate. Routledge.
Bovero, A., Leombruni, P., Miniotti, M., Rocca, G., & Torta, R. (2016). Spirituality, quality of
life, psychological adjustment in terminal cancer patients in hospice. European journal of
cancer care, 25(6), 961-969.
Campbell, C. S. (2017). Limiting the Right to Die: Moral Logic, Professional Integrity, Societal
Ethos. Euthanasia and Assisted Suicide: Global Views on Choosing to End Life, 191.
Chou, A. J., Geller, D. S., & Gorlick, R. (2008). Therapy for osteosarcoma. Pediatric Drugs,
10(5), 315-327.
Gum, A., & Snyder, C. R. (2002). Coping with terminal illness: The role of hopeful thinking.
Journal of palliative medicine, 5(6), 883-894.
Johnson, S. (2007). Hope in terminal illness: an evolutionary concept analysis. International
journal of palliative nursing, 13(9), 451-459.
Lee, Y. J., Yang, J. H., Lee, J. W., Yoon, J., Nah, J. R., Choi, W. S., & Kim, C. M. (2015).
Association between the duration of palliative care service and survival in terminal
cancer patients. Supportive Care in Cancer, 23(4), 1057-1062.

PASTORAL CARE IN LOSS 9
Maryland. (2017). Terminal and Chronic Illness Panel Case Studies
https://www.law.umaryland.edu/.../Terminal_Illness_Case_Studies.
Mialou, V., Philip, T., Kalifa, C., Perol, D., Gentet, J. C., Marec‐Berard, P., ... & Hartmann, O.
(2005). Metastatic osteosarcoma at diagnosis. Cancer, 104(5), 1100-1109.
Picci, P. (2007). Osteosarcoma (osteogenic sarcoma). Orphanet journal of rare diseases, 2(1), 6.
Surbone, A., Baider, L., Weitzman, T. S., Brames, M. J., Rittenberg, C. N., & Johnson, J. (2010).
Psychosocial care for patients and their families is integral to supportive care in cancer:
MASCC position statement. Supportive Care in Cancer, 18(2), 255.
Tsai, W. I., Prigerson, H. G., Li, C. Y., Chou, W. C., Kuo, S. C., & Tang, S. T. (2016).
Longitudinal changes and predictors of prolonged grief for bereaved family caregivers
over the first two years after the terminally ill cancer patient’s death. Palliative Medicine,
30(5), 495-503.
Vasudevan, S. (2003). Coping with terminal illness: A spiritual perspective. Indian Journal of
Palliative Care, 9(1), 19.
Wolfe, J., Grier, H. E., Klar, N., Levin, S. B., Ellenbogen, J. M., Salem-Schatz, S., ... & Weeks,
J. C. (2000). Symptoms and suffering at the end of life in children with cancer. New
England Journal of Medicine, 342(5), 326-333.
Balboni, T. A., Vanderwerker, L. C., Block, S. D., Paulk, M. E., Lathan, C. S., Peteet, J. R., &
Prigerson, H. G. (2007). Religiousness and spiritual support among advanced cancer
patients and associations with end-of-life treatment preferences and quality of life.
Journal of clinical oncology: official journal of the American Society of Clinical
Oncology, 25(5), 555.

PASTORAL CARE IN LOSS 10
Kaut, K. P. (2002). Religion, spirituality, and existentialism near the end of life: Implications for
assessment and application. American Behavioral Scientist, 46(2), 220-234.
Rabow, M. W., & Dibble, S. L. (2005). Ethnic Differences in Pain Among Outpatients with
Terminal and End‐Stage Chronic Illness. Pain Medicine, 6(3), 235-241.