Case Summary:

• You are Elaine Stuart, a 55-year-old high school math teacher.
• It is Friday, May 15th.
• You saw your oncologist, Dr. Johnson, on Monday, May 11th. You discussed more aggressive treatment for the cancer that has metastasized to your liver.
• Your oncologist, Dr. Johnson, strongly recommends continued aggressive chemotherapy, but you are ambivalent/very tired of it. The side effects that you are experiencing include mouth sores and diarrhea. You decided not to have a treatment this week, telling Dr. Johnson that you would let him know whether you would be continuing with chemotherapy.
• Because of the treatments, side effects and your discouragement, you have decided to stop working.
• You notified your school district that you can no longer work.
• You visited with a Hospice team on May 13th to learn about what Hospice can offer.
• You return to the resident today to discuss, in detail, what to do now.

Why You Are Seeing The Doctor Today:
You are seeing the resident today to focus on Hospice care versus more aggressive chemotherapy, as well as end of life issues.

Opening Statement:
In order to start all of the encounters in a similar manner, your opening statement should be about how you’ve been feeling. It’s hard to predict what the resident will say when he/she comes in the room; your response should be appropriate to the resident’s statement or question. For example:

The resident may ask you, "How are you doing, Ms. Stuart?"

• You would respond: "About the same, I guess. I really need to talk to you about my options for care at this point. I saw Dr. Johnson and talked to a nurse at Hospice this week. Now I’m trying to decide what to do."

Physical Description:

• Dressed neatly, but now looking "pale/haggard" (no makeup).

• You are concerned about what to do. It’s all very overwhelming.
• You appear rather agitated, fidgety.
• As the resident discusses your options with you, he/she should acknowledge or ask about your feelings or concerns.
• If he/she does not, you will become even quieter, as if you are thinking about something or are worried. Hopefully, this will prompt the resident to ask about your concerns, which are:
  • whether Hospice can really help (control pain, provide emotional support, help relieve your fears).
  • you wonder if you will need further surgery.
  • you’re not ready to enroll in Hospice care as yet.
  • you wonder if you’re giving up too soon if you don’t get more chemotherapy.
  • you are worried about how much pain & suffering you will have to endure.
  • you wonder how long you have to live.
  • it’s all very frightening.

• You had been healthy until 4+ months ago when you noticed rectal bleeding.
• No allergies.
• No hospitalizations (except tonsillectomy at age 9) prior to this illness.
• No serious prior illnesses except for pneumonia in 1980.
• Surgeries: Tonsillectomy as a child and bowel resection 3+months ago.
• Immunizations up to date.

The nausea and other symptoms you have recently been experiencing are somewhat under control:

• The current symptoms started about 3 weeks ago when you began experiencing nausea and some abdominal pain. The pain has gotten progressively worse each day. It is a constant, diffuse upper abdominal ache, about a "3-4 out of 10."
• You have lost 8 pounds in the last month.
• You have been feeling even more fatigued in the last few weeks. You suspect this is because of lack of sleep. Your sleep seems poor with frequent awakenings. After breakfast, you go back to bed for 3-4 hours until lunch. After lunch you lie on the sofa (sometimes dozing off again) until dinner (another 3-4 hours). After dinner you watch TV on the sofa until you retire at 10-11pm. You rarely go out of the house, and become quite fatiqued if you do (even if only for a short time).
• You are still having trouble falling asleep because of the nausea/pain, the worry, and because you are conflicted about what to do regarding treatment.
• You hate to "give up" but are so tired of it all. You really don’t know what to do, but you know you’re tired of the discomfort and pain.

• Prescription Medication: Compazine for the nausea. This is what you will answer when asked, "Are you on any medication?"
• Over-the-Counter Medication: Tried Extra Strength Tylenol, but it doesn’t help. Over-the-counter vitamins. This is what you will answer when asked "Do you take any over-the-counter medicine?"

Personal Habits:
Alcohol Use: A glass or two of wine on weekends.
Tobacco Use: None.
Caffeine Use: 2 cups of coffee a day.
Drugs (Illicit): No history of illicit drug use.
Vitamins: Take "One a Day," one tablet per day; occasional aspirin for joint aches.
Exercise: You don’t have time.
Health Insurance: You are covered under your school’s Independent Health Association Plan.

• You will respond the same to all interviewing styles.