Case presentation
A man in his late 80s living in Tokyo with his wife and two daughters
experienced sudden abdominal pain in July 2020 and went to seek help in
a nearby tertiary hospital. That same day, he had to undergo an
emergency laparotomy and appendicectomy after being diagnosed with
generalized peritonitis associated with perforation of appendiceal
cancer. Once the diagnostic tests were conducted, the patient was
confirmed to have Stage IV appendiceal cancer. Postoperative
contrast-enhanced CT scan showed no abnormal findings such as local
recurrence, lymphadenopathy, or distant metastasis associated with
cancer, but histopathological tests showed scattered lymphatic invasion
in the sub-serous layer.
Family members were informed about the severity of the disease
highlighting the need for palliative care. However, due to restrictions
imposed by the hospital amid COVID-19, the family members were not
allowed to visit frequently with the patients. Accordingly, they started
seeking updates on the patient’s condition through phone calls with the
medical staff. However, as family members were unable to understand all
situations/information clearly, there were few instances of
misunderstanding and even conflict between medical staffs and family
members. For example, there was an incident where the family members
thought that the intravenous drip was administered through the
peripheral intravenous catheter, but later they found it was
administered through the peripherally inserted central venous catheter.
This kind of incident was troublesome for family members, and they were
particularly concerned when medical staff asked them not to call too
often and told that medical staff would contact them directly if
anything happens to the patients.
Considering the patient’s desire to spend his final period at home with
his family and the restrictions on hospital visits due to pandemic, the
patient and his family chose to receive home care in November 2020.
After his discharge, home-care nurses visited twice a day and the home
doctor visited once every two weeks. This allowed the family to spend
enough time with the patient, which was not possible in the hospital due
to the restriction. Two daughters assisted his wife as family
caregivers, and professional caregivers provided physical care through
public nursing care insurance scheme. On weekends, his grandchildren and
great-grandchildren also visited him, and the whole family was able to
spend quality time with the terminally ill patient. Moreover,
communication between the medical staff and the family was also enhanced
as nurses used to communicate on a daily basis, and the doctor in charge
used to make house calls as needed. Finally, in April 2021, the patient
passed away peacefully after experiencing acute respiratory
distress syndrome (ARDS) caused by heart failure.