Palliative care

Palliative care assignment – Masters Level
Assessment Weighting (40%)
Patient scenario: Emma is a 43 year old, premenopausal woman of African American heritage. Her
family includes husband Scott, aged 45, and children Michelle, 16, and Max, 13. Two years ago,
Emma was diagnosed with Inflammatory breast cancer of the Left breast. She did not present with a
palpable tumour and it was not detected by a mammogram or ultrasound. She did present with some
sudden swelling (oedema) of the left breast, erythema, persistent itching, skin changes (peau
d’orange) and nipple retraction. Her diagnosis at the time was stage IIIB, and she was initially treated
with surgery (Mastectomy) and then radical course of external beam radiation therapy.
Since then, Emma has been hopeful of her prognosis, although over the past few months she has
been suffering from headaches. Unfortunately, two weeks ago Emma became increasingly
concerned about pain in her spine so she made an appointment with his radiation oncologist (RO). A
chest x-ray, CT and subsequent PET scan indicate the cancer has metastasised into the 4th Lumbar
Vertebrae (LV). Emma also has multiple lesions on her brain and has presented to the clinic with
evidence of raised intracranial pressure. Emma had an ECOG status of 2. Symptoms in the LV and
brain have been treated by steroids, analgesia and a course of 20Gy in 5Fx at 5/wk to the LV and
whole brain.
Emma returned home for a while after treatment, but unfortunately her health deteriorated further –
she did not appear to respond to the radiation therapy, and became largely confined to bed. She is in
the ward now undergoing palliative care. Her prognosis is not promising.
Using the above scenario as context for your discussion, and the evidence base from your unit
materials, textbooks and journal articles, you are required to:
· With respect to anatomy and physiology, briefly provide an explanation for the signs and
symptoms which Emma has presented with
· Describe the principles of palliative care in relation to this patient
· Critically analyse communication issues related to the dying patient
· Critically analyse the ethical issues in Radiation therapy practice with respect to palliative care
and death.
· Reflect on your own experiences from clinical practice
The report should be 2000 +/– 10% words.