Assignment
Anthony Vella is a 46-year-old man with stage 4 pancreatic cancer diagnosed six months ago after presenting to emergency with severe abdominal pain. Anthony has been married to Luisa for 20 years, they have two teenage children, aged 16 and 19.
Following his diagnosis Anthony underwent course of chemotherapy but his oncologist told him two weeks ago that further chemotherapy was unlikely to be effective. Anthony decides it is best to focus on the time he has at home with his wife Luisa. However, recent severe nausea and abdominal pain forced him to present to his local Accident and emergency. Anthony is admitted to the oncology ward where a referral is made to the Consultative Palliative Care team.
The Palliative team prepare an updated care plan which is implemented in an attempt to manage the symptoms he is experiencing. During the first few days interventions are focused on managing and assessing these symptoms, as well as addressing Anthony's and Luisa's psychosocial care needs. By day 5 Anthony's symptoms are greatly improved and he wants to return home to spend as much quality time with his wife as possible, under the care of community palliative care nurses. One of Anthony's palliative care nurses initiates a conversation about advance care planning, Anthony informs his nurse he will need more time to consider it.
It is expected that Anthony will need ongoing care with likely admissions to palliative care to manage his symptoms. A week later Anthony collapses in a shopping centre, he is non- responsive. A member of the public calls an Ambulance, he is then taken to the Emergency department of a major hospital. Anthony has not yet discussed advance care planning.
Questions
Please discuss the following questions, supporting your discussion with reference to relevant peer reviewed literature/evidence.
Discuss the possible benefits of Advance care planning for Anthony.
At what point might a conversation on advanced care planning be initiated with Anthony? There may be differing opinions on this within the literature, please describe these.
Who should be involved in this discussion of advance care planning with Anthony?
What sort of information would be included in the advance care plan? Discuss any supporting documents (relevant in Victoria) that may be included in the Advance care plan.
When would the advance care plan be reviewed?
When would the advance care plan be activated?