Michael E. Debakey VA Medical Center and Baylor College of Medicine, Houston,TX 77030, USAUnited States
Also available as PDF (figures and tables appear in the PDF).
Care of persons weighing over 500 lbs. poses additional challenges. For at least the past 20 years, training methods, resources, and equipment have been available to meet the demands of people weighing up to 500 pounds. However, this is not the case when exploring care options for the person weighing greater than 500 pounds. Hospital beds, magnetic resonance imaging (MRI) and computerized tomography (CT) scan beds, etc. are not usually designed to bear the weight of over 500 lbs. persons. According to Hale and others (2020), in 2017-2018 the age-adjusted prevalence of obesity in adults was 42.4%, and there were no significant differences between men and women among all adults or by age group. This case report illustrates the unique challenges and opportunities encountered by morbidly obese patients and healthcare professionals during end-of-life (EoL) care situations. It also categorically highlights the challenges, contextual discussions, and potential opportunities for healthcare delivery models to standardize and implement safe, effective, efficient, compassionate, person-centered, cost-effective care when serving bariatric persons.
Keywords: Bariatric patients; End-of-life; Compassionate care; Death with dignity; Palliative care physician
to provide best possible care to this lady during the last days of
her life, as an established and modernized healthcare facility, the Above discussion prompts some valuable insights. More invest-
patient’s ultimate phase of life was chaotic and undignified due to ment is needed in the continuum of care, holistic care approaches
unpreparedness of our health care system.
to bariatric patients both during death and decedent care coordina-
tion. Working together, a better future could be built with thought-
Subsequently, another challenge erupted which was a fully and pragmatically orchestrated implementation strategies to
roller coaster ride that felt like rearranging the deck chairs on the transform EoLC into a dignified, smooth and safe exit to another
Titanic.
horizon for all, but especially bariatric patients. Individuals work-
ing in silos may continue to raise the bar within their sphere of
End-of-life (EoL) journey should be an affordable and influence and expand their comfort zones. Healthcare delivery sys-
pleasant cruise and not a ride on the Titanic.
tems face a critical need to overhaul their models of care across
the continuum of care for this special patient population. Table 1 Challenges in current standardized and established
mentions some valuable and potential opportunities and recomhealthcare delivery models during EoL care (EoLC) provision to
mendations to facilitate such transformations.
terminally ill bariatric patients are listed in Table 1.
“One rain does not make a crop”. – native Indian saying.
There are potential opportunities for global healthcare delivery
Table 1. Challenges and Opportunities to Improve End-of-Life Care for Bariatric Person
Theoretical knowledge about special care needs of bariatric persons Clinical competence exists–but gaps prevail to translate such awareness to bedside care.
Equipment, space, and Limits exceed industry standards.
logistical needs
Caregiver and provider Unusual demands could lead to exhaustion, burn out and emotional Be vigilant and address compassion fatigue in both formal and informal
impact. distress
Standard Operating Unfamiliarity and sudden events could be potential barriers to facilitate Provide easily accessible “just in time” practical guidelines and benefit
Procedures death with dignity.
Post-death protocols and needs impose distinct delineation from Alert and engage decedent affairs, social workers, coordinate burial Decedent care established routines.
Direct care providers could potentially incur occupational injuries due Demonstrate sensitivity to operations, leadership engagement and Employee health and to extreme physical demands and necessary protective equipment to preoccupation with failure integral to High Reliability Organization (HRO) occupational hazards handle additional stresses etc.
Care of bariatric persons necessitates adjustments in staffing models Staffing models and expertise needed.
Communication skills, Terminally ill bariatric persons merit provisions for death with dignity.
sensitivity
Next of kin and surrogate decision makers, especially if not actively Offer effective bereavement services, facilitate a good closure for dying Family meetings, involved in patient’s care need much help to cope.
autopsy discussions Pathologists would benefit from focused requests and insights
Healthcare delivery Awareness, cooperation, and collaboration between various clinical, Collective, cohesive engagement and cumulative wisdom with shared goals
system care models administrative, academic, leadership hierarchal channels.
Be proactive and be prepared.
Disseminate best practices.
Emphasize person-centered care and innovative ideas.
Address and improvise alternate options as exceptions.
caregivers.
from subject matter and work experts.
benefits ahead of death.
concepts.
Align staffing models to deliver safe patient handling and care provision.
Facilitate and ensure critical communication skills and sensitivity among
healthcare teams
persons and survivors.
Engage in clear communications for targeted autopsy requests.
to provide excellent end of life care to bariatric persons to be the goal.