A 59-year-old man was diagnosed with pancreatic cancer that spread throughout his body. He insisted that his family understood his plans for everything and sought out advance care planning (ACP) himself.  The participants in our session were the father with cancer, a healthcare executive, his wife, and their son, an attorney. They all had been at the oncology visits but had unanswered questions about the future. His spouse, acting as the caregiver, also had concerns over conflicting views between her husband and their son over the treatment plan in the future.

Open Discussion Leads To Discovery.

After a more open discussion, it was discovered that the son had hopes for his father that did not match his father’s goals. The father made it clear that if treatments were not expected to benefit his quality of life he would rather forego what was offered. He wanted as little time in the hospital as possible and living in an institution, even for a limited time was unacceptable. His son expressed that he would prefer his father exhaust every option including enrolling in clinical trials and having his father live in a nursing facility. The son believed anything less would be unethical and “too difficult for my mom to bear.”

Conversation Within the Family Led To A Dramatically Changed Outlook.

Iris Plans educated them on the disease and the impact it would have on his quality of life. The sessions generated a great deal of discussion. As a result the father and son went on a recreational trip together to talk through differences. It was more time together than they had in years. By the final session, the son had a dramatically changed outlook. He supported his father’s wishes and plans and found that his mother, perhaps more than anyone else, was relieved by the outcome and new outlook.

With Iris’ help the solutions we put in place for our patient:

  • Defined the patient’s goals and priorities for his family and his caregivers

  • Decreased caregiver distress and family conflict

  • Defined the reasons to hospitalize the patient with clear limitations

  • Declined the use of skilled nursing facilities, rehabilitation hospitals, or other institutional healthcare residencies

  • Laid out patient preferences for various clinical scenarios

  • Completed Florida Medical Power of Attorney form

  • Completed Florida Directive to Physician form

  • Completed Iris Plans’ Disease Specific Advance Directive

  • Disseminated the ACP documents to the patient, family members, primary care provider, oncologist, and hospital

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