Case Study for Hospice Case: Pierre
Pierre had generally been healthy throughout his life. Then, at the age of 68 years, he received the news none of us wants to hear: He was told that he had cancer. Although the cancer was located in his liver, which does not usually carry a very hopeful prognosis, the doctors recommended exploratory surgery to better determine the extent of involvement of the tumor. Pierre agreed, and the surgery was performed. Unfortunately, it confirmed what the doctors had suspected: that the tumor was so large it could not be removed surgically. In addition, there was considerable evidence that the cancer was spreading to other vital organs. Thus, neither radiation therapy nor chemotherapy was likely to improve his situation or significantly lengthen his life. He was told that he had less than 6 months to live. Naturally, Pierre and his family were devastated.
Hospital staff immediately put Pierre and his wife Alicia in touch with a well-respected hospice program affiliated with the hospital. At the initial meeting, Pierre and Alicia met with their family physician, the medical director of the hospice program (an oncologist), a hospice nurse, and a social worker. They had met the oncologist briefly before and after the surgery, but did not know any of the others except the family doctor. They were nervous, but soon realized that everyone was there to help them. The purpose of the initial meeting was to meet one another, explain the services offered by hospice, and assess Pierre and Alicia’s needs. (Note that both Pierre and Alicia are being treated as consumers here. This is because the surviving spouse or other family members need hospice services as well as the patient.)
Pierre did not need much in the way of nursing care at first, but the hospice team explained that they would provide it as his deteriorating condition required. However, the team stressed that other hospice services, particularly social services and counseling, should begin right away. The social worker helped them to put together a list of legal and financial steps that should be taken, such as updating Pierre’s will. It was also decided that the family’s pastor would be involved in Pierre’s care.
In a matter of only a few weeks, the cancer had grown and spread to the point where it was sapping Pierre’s strength and his ability to function, and the hospice services increased. A nurse visited periodically and helped Alicia with his care. He needed regular pain medication and had to be catheterized. Because he had little desire to eat, a nutritionist developed a menu that would be more attractive to him while providing him with better nutrition to give him as much strength as possible. In the meantime, the family’s legal and financial matters were put in order, including, at Pierre’s request, funeral arrangements. Pierre also created a living will that specified that there be no heroic life-saving measures, even after he lost the ability to communicate clearly concerning his wishes.
A hospital bed was rented and placed in the home to make Pierre more comfortable and to make it easier for Alicia or others to attend to him. At first, hospice staff and volunteers came for a short time each day to give Alicia some relief. However, toward the end, when Pierre needed more complete care and observation, hospice volunteers stayed all night, allowing Alicia to get some rest. The primary concern of the hospice team was making Pierre as comfortable as possible and assisting Alicia. When oral pain medication would no longer suffice, hospice nurses gave him injections to ease his pain.
In time, Pierre’s end came. He died peacefully, with Alicia, the family pastor, and a hospice worker at his side. This did not end the work of the hospice team, however. They helped Alicia get through the funeral and assisted with the paperwork that is inevitably involved in such cases, including making sure the family lawyer got the estate settled. Although Alicia was very grateful for the services provided to her and to Pierre during his terminal illness, it was only when she was able to look back on it that she realized what a true godsend the hospice team had been for them.
Here is the citation for the book “Pratt’s Long-Term Care: Managing Across the Continuum, Fifth Edition” by Steven Chies, MHA in APA format:
Chies, S., & MHA. (n.d.). Pratt’s Long-Term Care: Managing Across the Continuum (5th ed.). Standish, ME: St. Joseph’s College.
Read the above Case Study: As the Ethical Leadership and Management Program Director of the hospice service agency that provided services to Pierre, you discovered that Personal Health Information (PHI) was shared with the family’s pastor prior to obtaining written consent from Pierre. Address the following concerns:
What ethical and privacy laws were violated?
What policy recommendations would be made to improve/assure the integration of ethical/privacy laws and regulatory measures to achieve optimal organizational effectiveness while adhering to personal and professional values in all elements of the healthcare delivery system?