End of Life Assessment Template

Patient Information: John Smith, a 78-year-old male, identifies as a practicing Catholic. Presenting Concerns: John has been diagnosed with advanced pancreatic cancer. Recently, he has experienced increased fatigue and significant weight loss. He is concerned about managing his pain and maintaining his dignity in his final days. Goals of Care: John wishes to remain at home surrounded by family. He prioritizes comfort and pain management over life-prolonging treatments. Medical History: John has a history of hypertension and type 2 diabetes, which have been managed with medication. He underwent a cholecystectomy five years ago. Medications: - Metformin 500 mg, twice daily - Lisinopril 10 mg, once daily - Morphine 10 mg, every 4 hours as needed for pain Symptoms: John reports severe abdominal pain and occasional nausea. He rates his pain as 8 out of 10 on most days, which impacts his ability to sleep and eat. Functional Status: John is mostly bedridden and requires assistance with all activities of daily living. His cognitive status is intact, but he experiences occasional confusion at night. Psychosocial and Emotional Needs: John expresses fear about the dying process and worries about being a burden to his family. His wife and two adult children are his primary support system. Spiritual and Cultural Considerations: John's Catholic faith is important to him, and he wishes to receive the sacraments as part of his end-of-life care. Advance Care Planning: John has an advance directive in place, specifying no resuscitation. His wife is his designated healthcare proxy. Environment and Supports: John is currently receiving hospice care at home. His family is actively involved, but they require additional support for overnight care. Clinical Summary and Recommendations: John is in the terminal stage of pancreatic cancer with a focus on palliative care. It is recommended to continue current pain management strategies and explore additional support services for the family to ensure John's comfort and dignity are maintained.