Sandra, a 47-year-old divorced woman, received a diagnosis of stage 3 ovarian cancer 4 years
ago, for which she had a total hysterectomy, bilateral salpingo- oophorectomy, omentectomy,
lymphadenectomy, and tumor debulking followed by chemotherapy, consisting of cisplatin
(Platinol), paclitaxel (Taxol), and doxorubicin (Adriamycin). She did well for 2 years and then
moved back to her hometown near her family and underwent three more rounds of secondline chemotherapy. She accepted a less stressful job, bought a house, renewed old friendships,
and became more involved with her two sisters and their families.
Sandra developed several complications, including metastasis to the lungs. Then she could no
longer work, drive, or care for herself. She had been told by her oncologist that there was
nothing else that could be done and that she should consider entering a hospice. She met her
attorney and prepared an advance directive and completed her will. She decided to have
hospice care at home and, with the help of her family, set up her first floor as a living and
sleeping area. She was cared for by family members around the clock for approximately 3 days.
Sandra observed that she was tiring everyone out so much that they could not really enjoy each
other’s company. At this time, she contacted the Visiting Nurse Association (VNA) to seek
assistance. Her plan was to try to enjoy her family and friend’s visits. After assessment, the VNA
nurse prioritized her problems to include fatigue and caregiver role strain. Other potential
problem areas that may need to be incorporated into the care plan include anticipatory grieving
and impaired comfort.
Reflective Questions
1. What are some of the stresses on Sandra’s middle-aged sisters and their families?
2. What resources are available to manage these stresses and support the sisters while
caring for their dying sister Sandra?
3. Describe Sandra’s feelings about dependency and loss of autonomy because she is
unable to do her own activities of daily living any longer
Sandra, a 47-year-old divorced woman, received a devastating diagnosis of stage 3 ovarian cancer 4 years ago, for which she underwent extensive surgery and chemotherapy. She initially responded well to treatment, but unfortunately, the cancer metastasized to her lungs, and she became increasingly debilitated. As her condition deteriorated, she decided to enter hospice care at home, where she could be surrounded by her family and friends.
Sandra’s decision to enter hospice care at home was undoubtedly a difficult one for her middle-aged sisters and their families. They were faced with the challenge of caring for their dying sister while trying to maintain their own lives and responsibilities. They likely experienced a range of emotions, including sadness, anxiety, and fear, as they watched Sandra’s health decline.
Fortunately, there are many resources available to support family caregivers in this situation. Hospice providers, such as the Visiting Nurse Association (VNA), can offer physical and emotional support to both the patient and their family members. They can assist with pain and symptom management, provide education and training on caregiving, and offer counseling services to help cope with the stress and grief of caring for a loved one at the end of life.
Additionally, there are support groups and counseling services available specifically for family caregivers of terminally ill patients. These resources can help alleviate some of the stresses associated with caregiving and provide a safe and supportive space for family members to share their feelings and experiences.
As for Sandra, it is understandable that she may feel a sense of loss of autonomy and independence as she becomes increasingly dependent on others for her activities of daily living. This is a common concern among terminally ill patients, as they struggle to maintain a sense of control and dignity in the face of their illness.
It is important for Sandra’s caregivers to be sensitive to her feelings and offer reassurance and support as she navigates this difficult time. They can involve her in decision-making about her care as much as possible and provide opportunities for her to express her wishes and preferences.
In conclusion, caring for a terminally ill loved one can be a challenging and emotional experience for family members. However, with the help of hospice providers, support groups, and counseling services, caregivers can find the resources and support they need to provide the best possible care for their loved one while also taking care of themselves.