Assignment
Scenario:
Marjorie was a 60 year-old woman who came to the hospice unit after a long hospital admission. She was a single woman who had enjoyed a rural life, including managing race horses and large property. Initially she was admitted to a hospital with Basal Cell Carcinoma, that despite initial surgical intervention, had infiltrated her brain tissue. Following a second surgical intervention she had been in an ICU where she was intubated and suffering seizures. After a successful extubation and anti convulsants, she was finally released from ICU. Unfortunately, following the surgery she also developed a deep intracranial infection that was not resolving. As her condition worsened, her brother requested palliative care. Marjorie became unresponsive at the hospital and it was agreed at that point that she would be transferred to hospice. Her family were her enduring power of attorney and were all clear that Marjorie was not for further burdensome interventions, and that hospice was the preferred place of death. Marjorie had skin integrity issues, increased frailty, and care was modified as her condition deteriorated. An early family meeting was held to re-establish goals of care, but as these meetings continued, Marjorie's condition stabilised. However, she became delirious, and depressed, and it became increasingly difficult to manage her outbursts. After 5 days, Marjorie eventually deteriorated, and died peacefully in her room.
Task
I. What is the role of family meetings early during an admission. How might this benefit a patient family and care team?
II. What strategies would be good for supporting staff and volunteers when patients are sometimes physically challenging?
III. What would be the multidisciplinary team look like for supporting patients and family members like Marjorie and her family?
IV. How might PCOC tools assist in assessing the care required by patients like Marjorie?
V. How might sudden cessation of medications affect Marjorie's symptoms and health?
VI. What are the different arrangements that can be made in relation to decision making for patients who no longer have the capacity? (Eg, Enduring Power of attorney, General Power of Attorney, etc).