I'm a home health nurse caring for a woman with metastatic cancer. Her oncologist says it's time for her to accept hospice, and some of my team members agree. But she's not ready for that and I want to support her. What should I do?-N.L., FLA.
Be her advocate-which includes providing superb nursing care to manage pain and other end-of-life symptoms.
Recently, an oncologist asked me to see the family of a terminally ill patient to "convince" them to stop seeking futile treatment and accept hospice. I agreed to see them without agreeing to his agenda. I entered the patient's room and softly introduced myself to two women, her sisters, who rose in unison from the window seat.
"She hasn't been fully conscious in days," whispered the woman in the yellow dress. "Could we speak somewhere else so she can rest?"
Seated in a conference room, I explained that I worked exclusively with dying patients and their families. I then asked the women what their sister understood about her condition.
"Oh, she's been through hell this past year. She knows we're at the end but she just isn't ready to give up."
"Joy, please don't even mention the word hospice," said the other sister. "Nancy associates it with death. She's told us many times that she wants to live and keep fighting to the end."
They seemed anxious about my visit, so I reassured them that I'd never attempt to badger a patient into making any decision about her care. I told them that I believed Nancy had every right to fight, even if medically futile, and I respected their decision to support her wishes. I also said I consider it inappropriate to tell a patient she's dying-the patient will tell us when she's ready. And Nancy wasn't ready.
The sisters were visibly relieved. They reaffirmed that they'd discussed end-of-life issues with Nancy many times over the past year, knew her opinions, and couldn't, in clear conscience, go against her wishes when she was no longer able to speak for herself.
I documented all of the above in Nancy's medical record, ending my note with my professional opinion-that it would be unprofessional to do anything with this patient besides support her decision and let her family love her.