Palliative Case Study Melissa is a 37-year-old woman with stage 4 bowel cancer diagnosed twelve...

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Palliative Case Study 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 month’s 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. Questions Needs to Answered In Case study Please discuss the following questions, supporting your discussion with reference to relevant peer reviewed literature/evidence. 1 Discuss the possible benefits of Advance care planning for Melissa. 2 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. 3 What preparations might need to make prior to this discussion? 4 Who should be involved in this discussion? 5 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?

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ADVANCE CARE PLANNING
Introduction 
Advance care planning assists person in putting forward their preferences related to health decisions and allows communication of decisions and choices that the chronically ill person aims to take for his family, friends or career. The person’s health and care choices need to be communicated essentially to plan the future course of medication or treatment for the betterment of the health service users along with important choices that needs to be made. Advance care planning is essential for people who are approaching end of life due to old age, chronic illness, multiple disease or cognitive impairment. The planning involves appointment of decision maker who acts in substitution or behalf of health service user and also provides a directive for advance care. The advance care planning involves a process of discussion and also records preferences for health service users which helps in determining goals related to care of health service users. This is done keeping in view the incapacity of health service users to communicate in future because of the potential side effects of the treatment that the individual is undergoing.
Benefits of Advance care planning 
Advance care planning has the potentiality for bringing about improvement to care in end of life processes. As mentioned by Brinkman-Stoppelenburg, Rietjens & Van der Heide, (2014), the implications of benefits of advance care planning apply to the health service users, her family, careers, health professionals and associated organisations. In case of Melissa, the benefits of advance care Planning will help to decide effective future plans for children and also ease the pressure on her parents who are undergoing ailments related to age-related problems. Moreover, the team of Metropolitan Health Services can also be made aware of the choices and preferences that Melissa aims to take regarding her advanced care consultations for health services to be required in the future courses. In due course of time her oncologists can also make informed decisions relating to the advanced treatment that needs to be provided to Melissa as a part of palliative care and provide Melissa with information regarding the possible outcomes and side effects of the advanced treatment (Thomas, Lobo & Detering, 2017).
The benefits of advance care planning that will be applicable in the given case study include ensuring possible help and care that is person-centred. In case of Melissa, she needs the help of external care because she lacks the support of her immediate family members as her parents are too old to take care of her and she is already separated from husband and his family. Hence for the sake of her health and advanced treatment in future and that of a children's Melissa with benefit from the advance care planning which will ensure that she has been provided with adequate care?
One of the other benefits of advance care planning and care provisions involves improvement in ongoing and end of life care which provides personal and family satisfaction to people. The families are well prepared in case of advanced care plans to deal with anxiety depression or stress and are comparatively more satisfied with the care provided to the person. In case of Melissa, her parents and her children can be well prepared for the upcoming situations and prepare them for taking steps related to the future (van der Steen et al. 2014). 
Healthcare professionals and associated organisations can benefit from advance care planning as it will help them to avoid confusion related to unnecessary transfers related to acute care and unwanted treatment. Melissa oncologist and Metropolitan health services can make informed and effective decisions related to Melissa's health and forward required promises that may provide adequate palliative care to her and her family (Reidy et al. 2017).
Initiation of conversation for advanced care planning 
Advance care planning initiation can be undertaken at number of crucial points and junctions in the ongoing treatment process of the individual. In Melissa’s case, the conversation for advance care Planning can be initiated at the earliest possible stage given the fact that her case has been turning unstable. This is because of poor prognosis as has been discovered by her through conversations with oncologist and other specialists as well.
As stated by Houben et al. (2014), a person indicating treatment relating to his or her ailment can mark off conversation relating to advance care planning. In case of Melissa, she has already raised concerns relating to her children's ongoing care and has expressed her desire for advance care planning from healthcare service providers. 
In case of hospitalisation,

Palliative Case Study 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...

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