Table 4:

Case presentation

A patient was diagnosed with leptomeningeal carcinomatosis from ovarian cancer and was contemplating palliative whole brain radiation therapy. Upon viewing the video, the patient wished to understand differences between “palliative” and “curative” treatments and prognosis. After this discussion, the patient opted to try radiation but had significant difficulty tolerating the face mask due to claustrophobia and pain. The patient decided to forego further attempts at whole brain radiation citing that the hassle, discomfort, and life-altering side effects were not worth the potential benefit of slightly increased longevity but no chance of cure.

The patient accepted the referral to palliative care and was seen five days after hospital discharge. At that time, the patient told the palliative care specialist she had decided to stop all cancer-directed therapies. Goals of care were discussed; do-not-resuscitate orders were signed, a health care proxy was chosen (previously none was listed), and the patient initiated home hospice. The patient noted a wish for more openness about the goals of treatment from the beginning of the diagnosis.

The patient died six weeks later without any subsequent emergency room visits or hospitalizations.