Because of the abnormal liver function tests, a staging CT scan is obtained and shows numerous new lesions in the liver and several pulmonary nodules consistent with progression of metastatic cancer.
With progression of the skeletal lesions and new visceral metastases, it’s clear that the current 2nd line chemotherapy is failing.
Mrs. Green’s oncologist advises the team that more chemotherapy is unlikely to work and will have significant toxicities. He recommends that the focus of care be on maximizing symptom control for quality of life and suggests a referral to the hospital’s palliative care team.
Mrs. Green’s resident brings up concerns the family has expressed about opiates as well as the nurses sense that the family does not seem to recognize how sick Mrs. Green is. The team decides that social work consult and a family meeting would be a good idea.
Reasons for Referral to Social Work at the End of Life
- High level of conflict between family and treatment team
- High level of distress in any family member
- Prior history of “traumatic” deaths/losses
- History of family conflict
- Unrealistic expectations of medical interventions
- Lack of resources that impacts on patient’s disposition