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
- What are some of the stresses on Sandra’s middle-aged sisters and their families?
- What resources are available to manage these stresses and support the sisters while
caring for their dying sister Sandra?
- Describe Sandra’s feelings about dependency and loss of autonomy because she is
unable to do her own activities of daily living any longer
Full Answer Section
- Financial stress. Caring for a sick person can be expensive. The sisters may be paying for Sandra's medical bills, as well as for the cost of home care. They may also be losing income if they have to take time off from work to care for Sandra.
- Social stress. Caring for a sick person can take a toll on the sisters' social lives. They may have less time for their own friends and family, and they may feel isolated from their community. They may also be struggling to balance their caregiving responsibilities with their other obligations, such as work and childcare.
There are a number of resources available to help Sandra's sisters and their families manage these stresses and support Sandra. These resources include:
- Hospice care. Hospice care is a type of care that provides support for people who are terminally ill and their families. Hospice care can help to relieve the physical and emotional stresses of caregiving, and it can also provide support for the family during the grieving process.
- Caregiver support groups. Caregiver support groups can provide a safe space for caregivers to share their experiences and to get support from others who understand what they are going through.
- Financial assistance. There are a number of programs that can provide financial assistance to families who are caring for a sick loved one. These programs can help to pay for medical bills, home care, and other expenses related to caregiving.
- Social support. It is important for Sandra's sisters to have a strong support system of friends and family who can help them to cope with the stresses of caregiving. This support system can provide emotional support, practical help, and companionship.
Sandra is likely feeling a range of emotions about her dependency and loss of autonomy. She may be feeling sad, angry, frustrated, and scared. She may also be feeling guilty about being a burden to her family. It is important for Sandra to talk to her sisters and to a therapist about her feelings. She needs to feel supported and understood during this difficult time.
Here are some additional resources that may be helpful to Sandra and her family:
- The American Cancer Society: The American Cancer Society provides a variety of resources for cancer patients and their families, including information on hospice care, caregiver support groups, and financial assistance.
- The National Family Caregivers Association: The National Family Caregivers Association is a non-profit organization that provides support and resources for family caregivers.
- The Compassionate Friends: The Compassionate Friends is a non-profit organization that provides support to families who have lost a child.