Let's Think About It Again
Hospice Under the Concurrent Care Model
Ms. Jones is a 57-year-old woman with a medical history of end-stage renal disease and is on hemodialysis. She has done well for years on her dialysis regimen and only recently has become increasingly fatigued, with weight loss and a new cough. She is found to have metastatic colorectal cancer with lesions in her liver, bones, and peritoneum, with symptomatic carcinomatosis resulting in recurrent bowel obstructions. She is doing well on palliative immunotherapy. She has an advance directive and designates her eldest daughter as her healthcare power of attorney. When thinking about the future, she hopes to focus on maximizing function and minimizing pain and nausea, with the hope that she can continue to volunteer at the local VA nursing home. She wants to allow a natural dying process.