title: [Using Shared Decision-Making on a Patient With Renal Cell Carcinoma and Subcutaneous Metastasis: A Care Experience].
abstract: When a patient aggressively receives treatment and looks forward to returning home, the prolonging of meaningful life is difficult, even with medical treatment. It is typically very challenging at this juncture for the members of the medical team to fully disclose to the patient the true extent of his / her condition and to recommend the withdrawal of life-support medical treatment. This article describes a nursing care experience with a renal cell carcinoma patient with subcutaneous metastasis. Her pain was induced by an edema and subcutaneous tumor in her lower limbs, which diminished the effectiveness of hemodialysis. During hospitalization, the mood of the patient shifted from looking forward to recovery to facing a rapidly worsening health status. Achieving a balance between fighting the disease and sustaining patient quality of life became increasingly difficult, and the patient began experiencing anxiety about dying. We use the belief of shared decision-making to guide the case in a discussion of her expectations during which primary medical care options and her choice to withdraw from hemodial-ysis treatment were explained. Essential oils, selected for appropriateness with her current disease stage, were used to stabilize her mood and relieve pain. In the end, we helped the patient to complete her pre-death preparations and to say goodbye to her children, parents, and siblings. As a result, the patient experienced a good death.
authors.affiliation: Department of Nursing, Chi Mei Medical Center, Liouying, Taiwan, ROC.
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Tsai
authors.affiliation: College of Nursing, Kaohsiung Medical University, Taiwan, ROC. chiuchu@kmu.edu.tw.
authors.forename: Chiu-Chu
authors.initials: CC
authors.lastname: Lin
mesh_terms: D002292:Carcinoma, Renal Cell / Q000451:nursing / Q000556:secondary*; D003657:Decision Making; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000451:nursing / Q000473:pathology*; D008875:Middle Aged; D012878:Skin Neoplasms / Q000451:nursing / Q000556:secondary*
keywords: death anxiety; good dying; renal cell carcinoma; shared decision-making