Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment. She is an active member of her church community and friends, comments that she had so much energy that she exhausted all of them just being around her. At age 51, she was diagnosed with non-Hodgkin’s lymphoma. Busy with raising her grandchildren, a little more than 3 years went by before she sought attention for her symptoms and was diagnosed. Despite aggressive treatments with chemotherapy and radiation, her diseased progressed and she was considering undergoing a bone marrow transplant. Climbing the stairs to the apartment one afternoon she became very short of breath and collapsed. Her twelve, year old granddaughter called 911. At the hospital she was minimally responsive and in severe respiratory distress. She was intubated and transferred to the ICU. A family meeting with the oncology and ICU team was called to discuss Mrs. Thomas’s advanced condition, the fact that she would probably not survive further treatment for the lymphoma and to develop a plan of care. Fifteen family members arrived, including her daughter, pre-teen granddaughters and grandson, three nieces, four nephews, several friends from her church and the minister. On being asked that only the immediate family participate in the meeting, the family and friends became angry and insisted that all of them be involved in this discussion. hat is your impression regarding this scenario? What are some concerns you have with this case? What do you anticipate would happen? How would you handle all the family members and friends wanting to be included in the discussion? There is not right or wrong answer. But remember you need a professional journal to support the discussion. 2. Now think about you being the patient. How would the situation be handle within your family? Have you thought about what kind of care you would want? Does someone know what you would want if you had a catastrophic event? Would family members support the decision maker’s decision for for you?


In the given scenario, Mrs. Thomas, a 54-year-old African American widow, mother, and grandmother, has been diagnosed with advanced non-Hodgkin’s lymphoma. She lives with her daughter and four grandchildren in a 4-story walk-up apartment. Mrs. Thomas is actively involved in her church community and has a strong support network of family and friends. However, when a family meeting is called to discuss her advanced condition and treatment options, tensions arise as the family and friends insist on being included in the discussion. This analysis will examine the concerns raised by this case, anticipate potential outcomes, and present strategies for handling the situation.

Concerns in the Scenario

Several concerns can be identified in this scenario. Firstly, there is a significant delay in seeking medical attention for Mrs. Thomas’s symptoms. This delay of over three years may have allowed the disease to progress to an advanced stage, which likely impacts her prognosis and treatment options. It is essential to address this delay and assess any underlying reasons for it, such as financial barriers or cultural beliefs.

Secondly, Mrs. Thomas’s respiratory distress and collapse indicate a severe deterioration in her condition, necessitating critical care in the ICU. This suggests that her disease has become terminal, and further treatment for lymphoma may not be feasible or effective. Given her precarious health status, it is crucial to initiate end-of-life discussions and establish a plan of care that focuses on minimizing suffering and maintaining her comfort.

Another concern is the manner in which the family and friends react to the request for a limited group to participate in the meeting. Their anger and insistence on being included may stem from a desire to be actively involved in decision-making processes and to support Mrs. Thomas. However, it is essential to ensure that the discussion remains focused and that the immediate family’s voices are heard and respected. Balancing the family’s desires for inclusion with the need for effective decision-making can be a delicate task.

Anticipated Outcomes

In this situation, emotions are running high, and tensions are escalating. It is likely that the presence of multiple family members and friends in the meeting will complicate the decision-making process. Conflicting opinions, cultural beliefs, and personal biases may hinder reaching a consensus or a clear plan of care. The risk of family dynamics becoming oppressive or overpowering to the immediate family’s needs and voices is also a concern.

The presence of the minister in the meeting introduces another dynamic. Religious and spiritual beliefs often shape end-of-life decisions, and Mrs. Thomas’s church community seems to play a significant role in her life. The religious leader’s opinion may carry particular weight, potentially influencing both the immediate family and the larger group’s perspective on treatment options and palliative care.

Handling the Family and Friends

To effectively handle the family members and friends wanting to be included in the discussion, several strategies can be employed. Firstly, it is essential to acknowledge the significance of Mrs. Thomas’s support network and the desire of her loved ones to be involved. This can be done by assigning a designated family representative who can act as the primary communicator between the medical team and the larger group. This representative should have a close relationship with the immediate family and be capable of relaying information accurately and advocating for their best interests.

Additionally, the medical team can organize separate meetings or forums for the extended family and friends to address their concerns and provide updates on Mrs. Thomas’s condition. This would create a space for them to feel included and involved without overwhelming the immediate family during the critical decision-making process. Providing resources, such as educational materials or support groups, can offer comfort and reassurance to both the immediate family and the larger group.

Furthermore, cultural sensitivity is vital in this situation. The medical team should take the time to understand the cultural beliefs and practices that may influence the family’s decision-making process. By demonstrating cultural competency, the medical team can build trust, foster open communication, and ensure that Mrs. Thomas’s care aligns with her values and preferences.


In the given scenario, the inclusion of multiple family members and friends in a family meeting to discuss Mrs. Thomas’s advanced condition raises significant concerns. Delayed medical attention, terminal disease progression, and conflicting opinions from the larger group necessitate careful handling. By employing strategies such as designating a family representative, organizing separate forums for extended family and friends, and demonstrating cultural sensitivity, the medical team can navigate these challenges and support the immediate family in making informed decisions about Mrs. Thomas’s care.