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Discussant Kathleen Foley, MD

JAMA. 1999;281:1937-1945.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR PARKER: Mrs L is a 44-year-old woman admitted to a Boston, Mass, teaching hospital with terminal cancer complicated by severe pain. She lives in the greater Boston area with her husband and has managed care insurance.

Mrs L experienced a flaccid left arm for 5 days prior to admission—the first manifestation of metastatic lung cancer. She also noted some mild weakness in the left leg accompanied by slurred speech and some drooling. There was no associated headache, change in vision, fever, or weight loss. She complained of mild shortness of breath and back pain. Her medical history is complex and notable for a seizure disorder since age 16 years, polycythemia vera, hemiplegic migraine, carcinoid, colitis, pseudotumor cerebri, and distal pancreatectomy for islet cell tumor.

Her medications on admission included phenytoin, 100 mg 4 times per day; primidone, 250 mg 3 times per day; acetazolamide, 250 . . . [Full Text of this Article]

MRS L: HER UNDERSTANDING AND PERCEPTIONS

DR D: HIS UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR FOLEY

Defining the Goals of Care

Barriers and Stressors in Palliative Care

Providing Palliative Care

Assessment and Management of Cancer Pain

Designing a Specific Drug Regimen

Listening to the Patient

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Foley is Professor of Neurology, and Member, Memorial Sloan-Kettering Cancer Center, New York, NY.

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