Case Study

 

MT is a 16-year-old young man with terminal brain cancer. At the age of 10, he was diagnosed with acute leukemia. After three years of intense treatment, MT was in remission. After two years of remission, during which he was doing very well in school and loved playing soccer, MT began having severe headaches. Unfortunately, his magnetic resonance imaging (MRI) scan showed a large mass requiring immediate workup. The tissue biopsy of the intracranial mass showed a uniformly fatal tumor, likely related to his previous leukemia treatment. No additional intervention was recommended by the team, and they wanted to refer him to hospice.

MT’s parents had heard stories in the media about the unprecedented recovery of children with terminal diagnoses. A  national search of experimental protocols for brain tumors revealed two centers that were considering starting aggressive surgical approaches to this devastating diagnosis, but no active studies were open at this time. MT’s parents were thinking about moving him to a different cancer center for another experimental treatment. A close friend of theirs had been successfully treated there after everyone else said nothing more could be done.

MT’s parents did not want him to know he was dying. They insisted on full code status. They forbid the nurses and resident physicians to tell him anything unless the parents were in the room, and they did not allow any conversation about his terminal condition and their recommendations.

When asked by staff, MT seemed to agree with his parents’ decisions in the past. Recently, however, he began to initiate conversations with the night nurse on the rare occasions when his parents were not in his room. One night MT was particularly agitated and asked to speak to a favorite resident physician who happened to be on call and his nurse, and without his parents present. This was a surprising request from MT; his parents were very upset, but they complied and left the room. MT shared with the resident physician and the nurse that he just accessed his health information from the patient portal that he and his parents signed up for a long time ago, and was upset to learn the name of his new diagnosis, glioblastoma multiforme (GBM). Through an online search, he discovered the extremely poor prognosis. He asked the resident physician directly, “Am I dying?” The nurse and resident physician had grown close to MT and wondered what they should do.

 

 

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Identify what you believe to be the most significant trend or change in the prescription drug benefit over the past 15 years. What impact do you feel this has had and to what degree do you think it will continue to have an effect?

Refer to the text and past experiences as you provide evidence to support your response. As you respond to your peers, consider reviewing the response of someone who chose a different trend.

  • Chapters 10, 11, and 12 in Essentials of Managed Health Care
  • Institute of Medicine (U.S.). (2010). Clinical data as the basic staple of health learning: Creating and protecting a public good: Workshop summary. Roundtable on Value and Science-Driven Health Care. Washington DC: National Academies Press. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK54296/
  • Reif, S., Torres, M. E., Horgan, C. M., & Merrick, E. L. (2012). Characteristics of practitioners in a private managed behavioral health plan. BMC Health Services Research, 12(3), 1-6.

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