Melissa is a 37-year-old woman with stage 4 bowel cancer diagnosed twelve months ago. Melissa now has developed liver metastases. Surgery was undertaken last year and an ileostomy was created. Melissa has two children: Joshua (15-year-old son) and Emma (12-year-old daughter). Melissa has been separated from the children’s father, Daniel, for about ten years. The break up was acrimonious but they manage shared care of the children. Daniel lives a few suburbs away, about a fifteen minute drive. Melissa has been working as a full-time administration assistant in a medium sized publishing company thirty minutes away from home. Melissa’s parents are both aged in their late 60’s and live in Queensland. Both parents have chronic health problems: Mum has unstable diabetes and Dad has COPD. She has regular email and phone contact, she previously visited her parents with the children during school holidays once each year. Neither parent is fit enough to travel to Victoria. Daniel’s parents both became estranged from Melissa following her relationship breakdown with Daniel. Their only contact with Joshua and Emma was while they were with their father. Daniels’ mother died three years ago. His father has re-partnered and now lives in a coastal Victorian town four hours drive from Melbourne. Melissa has been treated by the team at a metropolitan health service up until now. Melissa has had several frank conversations with her oncologist and other specialists, and is now aware of her poor prognosis.. As such, Melissa is very concerned about her children and their ongoing care. The subject of Advanced Care Planning has been raised and Melissa has expressed interest. An appointment with the Advanced Care Consultant at the health service has been made for Melissa in a months time. Last Saturday Melissa attended a 40th birthday party of a work colleague at a function centre in Oakleigh. While at the function, Melissa became unwell and collapsed. An ambulance was called and she has been taken to the Emergency Department at a nearby hospital. Question
1.Please discuss the following questions, supporting your discussion with reference to relevant peer reviewed literature/evidence.
2.Discuss the possible benefits of Advance care planning for Melissa. 3.At what point might a conversation on advanced care planning be initiated with Melissa? There may be differing opinions on this within the literature, please describe these. 4.What preparations might need to made prior to this discussion?
5.Who should be involved in this discussion? What sort of information would you include in the advance care plan? Discuss any supporting documents (relevant in Victoria) that may be included in the Advance care plan.
6.When would the advance care plan be reviewed?