Abstract
Physical activity has been increasingly recognized as a valuable supportive intervention in patients with end-stage disease. Furthermore, despite the presence of terminal disease, patients may desire interventions that promote an optimal level of mobility. For patients with metastatic cancer in the upper cervical spine, functional activity involves the possibility of pathologic fracture and resulting respiratory failure. The following case describes a high-risk, patient-centered intervention in a patient who desired transfer training despite a pathologic lesion in the second cervical segment and paraplegia from a pathologic fracture of the fourth thoracic vertebrae. The intervention was successfully delivered through collaborative efforts of a physical therapist and nurse practitioner with support of the hospice interdisciplinary team. Although the patient was not able to meet his goal because of disease-related complications, the interventions provided a sense of hope for the patient and family and highlight the importance of interprofessional collaboration in the management of complex patients in a hospice setting.