Pete is a 24 year-old African American man who was diagnosed with sickle cell di

Pete is a 24 year-old African American man who was diagnosed with sickle cell disease when he was 3 years-old. He has a history of acute chest syndrome, necrosis of the
hip, and has had recurrent chronic leg ulcers for 3 years. He had been receiving his treatment
from a Pediatric hematology group and recently transferred to the adult hematology clinic. Since the transfer, he has been hospitalized monthly for sickle cell pain crisis, with back, leg and chest pain which does not respond to his home pain regimen of Dilaudid. Pete has monthly pain crises at home, despite following an oral pain regimen that seemed to be working at home. After being admitted to the hospital via the ER, Pete is usually hospitalized for 1-2 weeks on an IV pain regimen, which he heard about from his peers with sickle cell disease. This specific combination of medication that he asks for is known to cause a temporary “high” and Pete reports it is effective. He has asked that the palliative medicine physician be removed from his case because they consistently push back on prescribing this combination of medication. Pete has a good relationship with the palliative care social worker and consents to them continuing to follow. Pete has been offered home health care services, but he refuses. He is cared for at home by his mother, who also cares for his two younger siblings, ages 14 and 17. He has good support from his mother. Pete is Christian and considers himself very religious. During one social work interaction, Pete revealed an incident of sexual harassment by an authority figure during his adolescence but refused to discuss further when pushed.
1. What additional information would you need to assess the client, including the family?
2. What NJ federal or state laws or regulations are relevant to this case?
3. How would you address them?
4. How do these affect the intervention that you have chosen for this case?
5. What are the palliative care issues presented in this case?
6. What interventions or decision would you recommend for this patient, (and family, if appropriate) based on the information included in the case and information that you would obtain? If information not included in the case is necessary to make a decision about treatment, discuss how the information you obtain would affect your recommendation for treatment.
7. What is the role of the social worker for this case?
8. What is the role of the other members of the Palliative Care Team? Why?
9. What is in the evidence base about how individuals from this cultural group approachserious illness and end of life, including:
a. Engaging in advance care planning
b. Preferred communication style about diagnosis and prognosis
c. Preferences regarding aggressive life-prolonging treatment
10. What are the ethical issues to consider in this case, including:
a. Relevant ethical values
b. Potential ethical dilemmas
11. What are the religious or spiritual issues that should be considered?
Include 7 peer reveiwed references about total pain in palliative care, existential suffering, and adolescents and adults living with a chronic illness experiencing palliative care