I saw an elderly female patient recently. She had two adult children, a daughter and son. The daughter was her official decision maker, but the son was very pushy. The patient was set to go home on hospice, but her son wanted her to continue chemotherapy treatment and was even pushing for more testing to be done. It became a huge ugly scene. I felt at a loss for trying to figure out what to do. Any suggestions?

This is a difficult situation that happens more often than you might think. Family dynamics, relationship issues, and even guilt may be at play. Does your hospital have a palliative care team? They are skilled at handling situations like these. This would be an appropriate referral, one you could ask the primary care physician or medical oncologist to make. Otherwise, a licensed clinical social worker might be able to help. No matter who you consult, be sure to keep your focus on what the patient wants.

In this situation, you might see the patient privately first to review with her what she wants and then use this information as a strategy when explaining things to the son. It is best to pull in other resources in cases like these rather than trying to handle the problem yourself. Your supervisor or chaplain may also be able to help. — Ann J. Brady, RN, BSN

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