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.