Mr. Brown, who was your eighth-grade science teacher, has been a patient in your practice for many years. Several years ago, he was diagnosed with cancer and has been undergoing treatments. He recently was told that his cancer was no longer responding to treatments and that his condition is terminal. Mr. Brown, along with his wife and daughter, have scheduled an appointment to discuss palliative care and what can be expected. Although Mr. Brown’s death is not imminent, his care needs clearly will continue to increase, and they will continue until his eventual death from the disease. The disease process is typically accompanied by an increasing level of pain, which is of great concern to Mr. Brown and his family. The meeting today is intended to determine whether the patient and the family feel that palliative care is appropriate.

Case Questions

1. What are some open-ended questions that can be asked to explore the need for palliative care?
2. The decision is made to proceed with palliative care, and a plan to manage pain is being developed in partnership with Mr. Brown and his family. What does total pain management entail, and why is managing total pain important to the well-being of Mr. Brown and his family?
3. How should Mr. Brown’s spiritual well-being be evaluated, and why is it part of total pain management?
4. As you learn that Mr. Brown’s level of pain has increased since his treatments ended, you suggest the use of opioids for pain management. Mr. Brown’s daughter expresses concern about the use of opioids to manage pain, stating, “Aren’t opioids bad? I hear about people dying from opioid abuse on the news all the time.” What information should you provide to assuage the daughter’s concern?
5. As the disease process progresses, the patient begins to demonstrate signs of dyspnea, including confusion and anxiety. What treatment should be initiated, and what are important considerations when initiating this treatment?