Deirdre, a 43-year-old woman with a diagnosis of metastatic cervical cancer, is admitted to the hospital. She has experienced a lot of pain at home and is not sleeping well. She is tearful and upset a lot of the time. Her mobility has deteriorated in recent weeks, and she now requires a rollator to walk. Deirdre has two children, Tom, aged 14, and Sophie, aged 8. Deirdre is separated from her husband and lives with her partner Harry, who is the father of Sophie. Deirdre’s mother died when she was 9 years old. Her father is supportive but does not visit often. She has three siblings. Deirdre and her eldest sister have a history of anxiety and panic attacks. Her sister also has a history of alcohol abuse but has not had a drink in 3 years. Harry was working full time until recently but has had to take time off work to manage hospital appointments and childcare. Deirdre’s siblings are asking a lot of questions about Deirdre’s condition.
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1. What psychosocial issues do you think could be contributing to Deirdre’s current distress?
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Correct answer:
Deirdre is worried about herself and the future and could benefit from counselling support. Body image and adjusting to changes in functioning are significant issues. She is not sleeping at night as her mind is racing and she is fearful and anxious. Her diagnosis raises the past loss of her mother and the changes that occurred in her family. Sophie is similar in age to Deirdre when her mother died.
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2.As well as counselling support, what support could Deirdre and her family benefit from?
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The family are experiencing financial distress as Deirdre can no longer work and Harry has had a reduction in wages from taking so much time off to care for Deirdre and the children. Information about other benefits or applications for charitable assistance could help relieve some of this stress.
Deirdre and Harry need support and information about talking to the children about the changes in Deirdre’s condition. Harry does not feel able to talk to Tom about how he is feeling. The social worker could also meet the children for support (with parental consent).
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3. Are there specific interventions you would consider to support the family?
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Correct answer:
A family meeting can be a useful way of sharing information with everybody in the family. It can help raise issues of worry and concern. It could also explore what support Deirdre’s siblings might be in a position to offer Harry and the children.
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4. Are there particular people in the family identify as possibly needing support?
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Correct answer:
Harry’s role as carer is becoming more stressful. Discharge planning should include review of carer supports, formal carers as well as family/friends who may be able to assist with childcare. Future care planning including reviewing adaptations needed at home is important.
Deirdre’s elder sister may need individual support. She has a past history of addiction and currently experiences anxiety and panic attacks. She also experienced the death of her mother when she was a child. Some of the difficulties in her life relate to this time, when she took on a caring role for her younger siblings. Deirdre’s eldest sister worries Tom will be given too much responsibility around the house.
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5. Are there legal issues to be explored or raised?
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Correct answer:
Harry is Sophie’s biological father, but not Tom’s. In some countries, unmarried fathers are not automatically legal guardians of their biological children. The social worker would be a good resource to the team in explaining the legal context. They can explore options about guardianship and future care of the children with Deirdre, Harry and Tom’s father.
