Case Report| Volume 11, ISSUE 7, P528-530, September 2010

End-of-Life Care in a PACE Program: Respecting the Patient's Wishes While Supporting the Caregiver

  • Abisola B. Famakinwa
    Address correspondence to Abisola B. Famakinwa, MD, Geriatrics and Extended Care, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730.
    Staff Physician, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Instructor in Medicine, Harvard University, Boston, MA; and Medical Director, Elder Service Plan of Cambridge Health Alliance from 2005–2006
    Search for articles by this author
      Family caregivers play a key role at the end of life. They provide high levels of assistance and are often called on to make complex medical decisions. This is a period where there is potential for conflict, particularly when the patient lacks decision-making capacity. This case report describes how an interdisciplinary team helped an end-of-life caregiver to find closure while advocating for the patient's wishes to be carried out. The intervention of appropriate advanced care planning and frequent communication resulted in a positive outcome.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hirth V.
        • Baskins J.
        • Dever-Bumba M.
        Program of all-inclusive care (PACE): Past, present, and future.
        J Am Med Dir Assoc. 2009; 10: 155-160
        • Wolff J.L.
        • Dy S.M.
        • Frick K.D.
        • Kasper J.D.
        End-of-life care: Findings from a national survey of informal caregivers.
        Arch Intern Med. 2007; 167: 40-46
        • Singer P.A.
        • Martin D.K.
        • Kelner M.
        Quality end-of-life care: Patients' perspectives.
        JAMA. 1999; 281: 163-168
        • Steinhauser K.E.
        • Christakis N.A.
        • Clipp E.C.
        • et al.
        Factors considered important at the end of life by patients, family, physicians, and other care providers.
        JAMA. 2000; 284: 2476-2482
        • Rabow M.W.
        • Hauser J.M.
        • Adams J.
        Supporting family caregivers at the end of life: “They don't know what they don't know”.
        JAMA. 2004; 291: 483-491
        • Baker R.
        • Wu A.W.
        • Teno J.M.
        • et al.
        Family satisfaction with end-of-life care in seriously ill hospitalized adults.
        J Am Geriatr Soc. 2000; 48: S61-S69