[Caring for a Patient With Rare Urachal Carcinoma and Facilitating Family Medical Decision-Making: A Case Report]

This case was a 28-year-old male patient newly diagnosed with metastatic urachal carcinoma who presented with abdominal distension. Metastatic urachal carcinoma is rare and highly aggressive and associated with poor prognosis. The care period was from November 7, 2022 to May 16, 2023. On hospital day four, the patient developed acute respiratory distress, which required endotracheal intubation and transfer to the intensive care unit. The nursing practitioner facilitated cross-coordination between oncology and critical care teams. The "Patient-Centered Care" concept and "Four Quadrants" ethical framework were applied to address dilemmas in medical decision-making. Clinical information was primarily obtained from the patient's mother. This case highlights the challenges involved in respecting patient autonomy regarding chemotherapy, managing severe tumor lysis syndrome with acute kidney injury complications, and dealing with family conflicts regarding medical decision-making in end-of-life care. By coordinating across the healthcare team, we effectively managed a complicated and evolving clinical course. This case report was prepared to share our experience as a reference for clinical nursing practice.