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Case: Metastatic lung cancer

Case Management Weekly, April 14, 2004

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A physician refuses to consider hospice care for a dying 66-year-old woman with metastatic lung cancer-even when the case manager raises the idea in a casual way. The nurses overhear the family talking about their wishes to take the man home to die in peace. It's this hospital's unstated policy that the case manager cannot initiate a discharge plan unless it is first ordered by the physician. But this can lead to poor outcomes, says one social worker. "Some patients never make it to hospice care in their home because the doctor wants to keep trying, even though the family wants something different. It's a difficult issue," says Ann Patterson, SW.

How would your team handle this case? Any success stories for effective outcomes? Let us know by emailing rdelaney@hcpro.com or sending us a letter to: Editor, Case Management Training Monthly, 200 Hoods Lane, Marblehead, MA 01945.

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