Harry is admitted
to hospital

Harry is admitted to hospital

View Harry’s story below.

Harry is a 67 year old man admitted under the neurosurgical team with a pathological fracture of his lumbar spine. The fracture was found to be secondary to a bone metastasis from what has now been diagnosed as advanced metastatic renal cell carcinoma.

He is a jovial, engaging man, now retired and a widower of 5 years. He lives alone, manages independently, and enjoys gardening. He has one adult daughter who lives 3 hours away and works as an enrolled nurse. She sees him intermittently.

Harry’s bone cancer-related fracture puts him at risk of a catastrophic spinal cord injury. He has significant comorbidities, including severe ischaemic cardiomyopathy and coronary artery disease. The neurosurgical doctors have looked at his scans and are prepared to offer surgery to stabilise his fracture, but he is a high-risk surgical candidate.

Since admission, he has had various conversations with members of the nursing staff as to whether he should have the surgery or not. He agrees to the surgery. However during the morning ward round on the day of surgery, you observe the resident asking Harry to sign the consent form. Harry is now ambivalent.

Audio “There could be a serious risk to your spinal cord if you don’t have this surgery. You are booked in this afternoon”.

Audio “Look can we just leave it for now; my back hurts, and I’m finding talking about all this too difficult.”


Which of the following best represents your thoughts about how to proceed?

Explore more of the options above or proceed to the next screen to see the multidisciplinary team discussion which ensued after Harry declined to talk further.