A 75-year-old male presents to the clinic with generalized fatigue, weight loss, and chronic abdominal pain. He was diagnosed with pancreatic cancer a year ago and has not responded to multiple chemotherapy treatments.
A CT scan reveals a tumor in the head of the pancreas with widespread metastases to the liver and peritoneum, along with malignant ascites.
Over the past six months, his ability to perform daily activities has significantly declined, and he now spends most of his time in bed.
During the visit, his family is adamant about continuing aggressive treatment, believing that “one more round” of chemotherapy might give him a chance. The patient remains passive during the discussion, nodding along with his family’s requests but does not directly express a preference.
An oncology consult one month ago concluded that further chemotherapy would provide no clinical benefit and might exacerbate symptoms. His palliative care team previously discussed a comfort-focused approach, but his family wants to pursue all possible treatments.
What is the most appropriate next step?
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