A 28-year-old woman with a diagnosis of glioblastoma multiforme has recently decided to transition to hospice care following intracranial surgery and a course of chemotherapy. She has been informed by her oncologist that her prognosis is poor and that she will likely not live more than 6 months. The physician overseeing the hospice team visits the patient's home for a follow-up. During this visit, the patient mentions that she has been having second thoughts about choosing hospice care and, after speaking with family members and friends, feels that this would be "giving up." Her twin brother will be getting married in 8 months and she wants to attend his wedding. She has consulted 2 other oncologists who are experts in the field of glioblastoma for second opinions; they recommend an experimental life-prolonging chemotherapy regimen. She says, "I feel like I have to give this a try." Approximately 8 weeks later, the hospice team is contacted by the patient's twin brother. He says that the experimental treatment did not go as planned and the patient suffered multiple complications, including toxic epidermal necrolysis, respiratory failure, and ischemic brain damage that required a stay in the intensive care unit. A ventriculoperitoneal shunt was placed due to increased intracranial pressure. All family members are in agreement that the patient should return to hospice for comfort care. The patient is unable to indicate whether she wishes to return to hospice or continue pursuing curative treatments. Which of the following is a contraindication to the patient returning to hospice?

Question

A 28-year-old woman with a diagnosis of glioblastoma multiforme has recently decided to transition to hospice care following intracranial surgery and a course of chemotherapy.  She has been informed by her oncologist that her prognosis is poor and that she will likely not live more than 6 months.  The physician overseeing the hospice team visits the patient's home for a follow-up.  During this visit, the patient mentions that she has been having second thoughts about choosing hospice care and, after speaking with family members and friends, feels that this would be "giving up."  Her twin brother will be getting married in 8 months and she wants to attend his wedding.  She has consulted 2 other oncologists who are experts in the field of glioblastoma for second opinions; they recommend an experimental life-prolonging chemotherapy regimen.  She says, "I feel like I have to give this a try." Approximately 8 weeks later, the hospice team is contacted by the patient's twin brother.  He says that the experimental treatment did not go as planned and the patient suffered multiple complications, including toxic epidermal necrolysis, respiratory failure, and ischemic brain damage that required a stay in the intensive care unit.  A ventriculoperitoneal shunt was placed due to increased intracranial pressure.  All family members are in agreement that the patient should return to hospice for comfort care.  The patient is unable to indicate whether she wishes to return to hospice or continue pursuing curative treatments.  Which of the following is a contraindication to the patient returning to hospice?

Quizplus · Accepted Answer

Explanation: For patients (and family members) who decide to pursue hospice care, there are no contraindications provided the patient has an estimated prognosis of <6 months and has decided to forego curative treatments. This decision should be made when curative treatments are no longer beneficial or when the suffering associated with medical treatment outweighs the benefits. Although there is no advance directive and this patient is unable to indicate a choice (and therefore cannot give consent), family members, functioning as surrogate decision makers, can offer a substituted judgment in which they decide for the patient based on what she would have wanted under these new circumstances (Choices B and C).(Choices A and E) Medical conditions such as ischemic brain damage and preexisting medical interventions such as a ventriculoperitoneal shunt are not contraindications to hospice care. Educational objective: The only requirements for hospice care are a prognosis of <6 months and the patient's or surrogate's decision to forego life-sustaining treatment. Physicians should educate patients and family members that comorbid medical conditions and inability to give full informed consent are not contraindications to hospice care. References: Understanding palliative care and hospice: a review for primary care providers. (http://www.ncbi.nlm.nih.gov/pubmed/28160875)

A 28-Year-Old Woman with a Diagnosis of Glioblastoma Multiforme Has