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Maria is a Puerto Rican woman who was diagnosed with breast cancer at age 35. During the three and half years that she lived after diagnosed, she received a variety of services from a cancer support organization, including weekly individual supportive counseling with a social worker and group therapy. At the time of her diagnosed, Maria had been married to Joseph for 13 years. They experienced fertility problems because of her cancer treatment. Maria reported to her Social Worker that this was a major source of conflict in the relationship and that she did not feel emotionally supported by Joseph.

Maria began working in a bank at age 17 and by age 30 had attained a middle management position. For two years after diagnosis, she worked full-time while receiving chemotherapy every three weeks, refusing to take time off for her cancer treatments. She reported significant depression, anger, and apprehension about recurrence. Within six months of diagnosed, she had begun to reexperience previous losses, most significantly the loss of her mother to breast cancer when Maria was 10 years of age. She reported consistent faith that the chemotherapy would cure her mother and hopeless betrayal by God when her mother died. Her oncology social worker suggested a referral to a psychiatrist for Maria’s worsening depression, which Maria declined, saying that she did not wish to take antidepressant medication.

Ultimately, Maria agreed to a stem cell transplant and left her job after a year of disability leave. She agreed to see a psychiatrist for a one-time consultation yet continue to decline antidepressant medication. The social worker reported that she became increasingly fatigued, depressed, and agoraphobic (e.g. she stopped going out alone secondary to panic attacks). Her cancer recurred after one year and she died 18 months later.

Answer these questions based on your interpretation of Maria’s case:

  1. How do you think that Maria defined good quality of life?
  2. What do you see as the social worker’s role in providing support to clients like Maria who would help them to achieve good quality of life as well as good quality of death?
  3. Arthur Kleinman (1988) offers an explanatory model of illness that fosters a sensitive approach to helping clients like Maria. How might you have used his approach to elicit information from Maria to maximize your ability to help her? Recall that Kleinman suggested using these questions: What do you call the problem? What do you think caused the problem?
  • Why do you think it started when it did?
  • What do you think the sickness does? How does it work? How does it affect your body?
  • How severe is the sickness? Will it have a long or short course?
  • What care do you desire? What are the most important results you hope to get from your care?
  • What are the chief problems the sickness has caused?
  • What do you fear most about the sickness?
  • 4. What do you consider to be the most pressing medical, psychosocial, and spiritual concerns that Maria faced? How would you prioritize these concerns in devising your approach to treatment?
  • 5. How would you go about developing a plan of care for Maria that takes into account her cultural and spiritual perspectives and emphasizes her definition of good quality of life?
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