Benefit of Advance Care Plan for Patient Suffering from Motor Neuron Disease Assessment 2 Answer
Assignment 2: Case Study
Assessment type: Case study Length: 1500 words (+/- 10%)
Weighting: 35% Instructios:
Bob is a 64-year-old gentleman. Bob was diagnosed with motor neurone disease (MND) just over a year ago, and because of his work as an electrician, it was deemed too dangerous for Bob to keep on working. Bob has no other medical past history and had been fit and well prior to diagnosis. Bob and his wife Margaret initially didn’t know what motor neurone disease was, as such Bob’s neurologist referred Bob and Margaret on to the MND association. Bob found the MND information pretty confronting at first. Bob found the MND brochures to be very frank about what happens.
Bob reflects on his diagnosis
“ MND is a cruel disease. I was really angry for a few weeks and you immediately think ‘why me’, ‘why now’. I didn’t take it very well, I really took it out on the family. Everyone’s different of course but you’ve just gotta do what’s best for you. I found others that were coming to terms with issues like ‘what it’s like to not be the bread winner anymore’ and you know that sooner or later you’re going to have to relinquish some of your responsibilities, but you just can’t do everything. These were some of the hardest adjustments I’ve had to make, but it’s hard when you think people just aren’t listening to what you want. Everyone seems to be an expert on what you should be doing.”
Three months later Bob's illness progresses. Bob has severe weakness in his arms but is still able to walk around. Bob has been referred to a physiotherapist and occupational therapist to determine what can be done to improve his physical and social functioning. When the physiotherapist visits Bob, she finds Bob is increasingly experiencing speech difficulties and is becoming frustrated by his decrease in independence.
You are required to write a case -based essay that answers the following questions. You are not required to discuss Bob’s specific medical diagnoses; the focus of this essay is to explore the role of advance care planning in the context of Bob’s chronic illness progression.
- Discuss the possible benefits of Advance care planning for Bob and Margaret
- At what point throughout Bob’s illness trajectory might a conversation on advanced care planning be initiated with Bob? There may be differing opinions on this within the literature, please describe these.
- What sort of information should 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 and activated?
When you plan your essay, consider a person-centred approach to support your discussion. You need to support your discussion with high quality, peer reviewed literature. Your essay needs to draw from legislation that is relevant to Victoria, as laws and legislation vary both nationally and internationally.
In your essay:
- Identify Bob, his relevant past history and how it applies to the progression of his chronic illness to set the context for your discussion.
- Include an introduction, body and conclusion in your essay. Use headings to indicate the topic you are discussing. The four essay questions can be used as heagings.Please refer to the La Trobe University Nursing & Midwifery Assessment Presentation
- Ensure you have clear and logical transitions between the introduction, body, and conclusion.
- Discuss why advance care planning is important in relation to person centred care, and informed decision making by drawing from your research sources and their arguments. You are required to use peer reviewed, scholarly articles to support each point you make. You may use Australian government or other authoritative websites as a point of reference, however the use of web- based sources, or any non
Case Study Based Advance Care Planning
Advance neurological disease like motor neuron disease is life-limiting and can have devastating effects on the mental and physical well-being of the patient, caregivers and families. Motor neuron disease is a progressive disease which has the deterioration of the characteristic neuromuscular function later restricting major life-sustaining processes. The early commencement of the advance care planning allows a patient to participate in future care choices which are available in his case. The purpose of planning in such patients is to focus on increasing the compliance and quality of life. Also, the ethical considerations need to be considered in progressive neurological condition. The objective of this essay is to discusses the benefit of an advance care plan in the patient suffering from Motor neuron disease. The essay also aims at discussing the introduction of the care plan with the patient and the family as per the guidelines of The Medical Treatment Planning and Decisions Act. The essay reflects the information presented in the advance care plan as per the case study included.
In the case of Bob planning an advance care plan can achieve more favourable outcomes when associated with therapeutic planning to have better health care outcomes in future. As the nature of Bobs condition is progression marked by walking difficulties and then speech restriction it reflects his condition is deteriorating continuously. It proves more beneficial for the decisional capacity loss in future.
ADVANCE CARE PLANNING
This is a person-centric approach used for the purpose of planning the current and future health and personal care which include the value, beliefs and preferences of the patient. This is a collaborative and coordinated effort which is aimed at developing an understanding of the individual
treatment and goals in order so that health care professionals can be assisted to meet the need. The nature and timing of the advance care plan discussion are driven by the need of the individual patient and is influenced by the willingness of the individual to participate. Ideally, an ACP discussion is initiated early for those with a life-limiting illness like motor neuron disease as in the case of Bob. This is done to optimize the quality of life and minimise the potential burden of unwanted treatment.
THE ADVANCE CARE PLAN INCLUDES
The assessment of the current condition of Bob with the probable prognosis, it also aims at establishing the goals of the for Bob and Margret as per their needs in terms of health and personal aspects. Also, an advance care plan discusses the possible treatment options available and how the burden of undue medications can be avoided. It identifies his and the family decision-making capabilities for the time it may be required as at the end of life protocol decisions. It also reflects long term treatment assistance in term of goals met as per the preferences. Formal documents are also restored for future references (Rietjens et al., 2017).
BENEFITS OF PLANNING ADVANCE CARE PLANNING FOR BOB AND MARGRET
As Bob has mentioned that he has difficulty initially to understand the course of diseases and struggle to adjust with the limitation caused by the disease, planning for advance care plan will help Bob in higher understanding of the quality of life. Also, ACP will increase compliance with patient preferences. As Bob and Margaret continuously need to make adjustments to their lifestyle due to disease progression which may affect the movement of limbs, breathing and lastly the bulbar function of Bob (Oliver D, 2016). Advance care planning allows them to plan whether there is consideration required for medical interventions and ultimately how they want the care and death to be managed. It also diminishes the likelihood of stress, depression and anxiety among the relatives. It reduces the disagreement, ambiguity and misunderstanding among family members.
WHEN TO INITIATE THE ACP DISCUSSION
Advance care planning is something which might not be embraced by Bob and Margaret as initially she was not well aware of the disease and seems challenged in understanding things clearly hence the question might arise the time for the introduction of the advance care plan to them. Any healthcare professional might be worried about the delay in ACP as delay decision making may affect future care and health outcomes (ML, 2017). This could lead to the conflict of perception causing disarranged therapeutic relationship with Bob and Margaret.
There is no specific time-bound limitation when an advance care plan should be discussed with bob but it depends on various factors like urgency, symptom progression etc. Many evidence-based indicators have been established by the literature available (Hemsley et al., 2019). As Bob is suffering from motor neuron disease his indicators may include increasing cognitive difficulties, the rapid decline of the physical status and loss of vital capacity more than 70 per cent. A progressive decline in the functions like functions, speech, communication, cognitive ability is the time to discuss the ACP with Bob and Margaret.
Robinson et al, 2012 have opinions regarding how the discussion should be carried. They mentioned in research that it should be initiated as early as possible in the course of personal illness and is not a one-off process. It should involve several health professionals and should be conducted under various consultations.
Detering et al., 2019 believed, that it is preferable to have the discussion when a person is medically stable and can participate in the discussion, however, this may not be possible in the cases when the person is severely ill therefore it is never too late to attempt for the ACP discussion.
Further literature showed that when a person like Bob becomes unwell it is helpful to tell them that usually, we have more time in hand for such discussions which is not possible in the current situations. This holds true especially in a situation like resuscitation planning.
A review by Field et al., 2014 suggested that linking decisions about resuscitation to a discussion about the overall treatment plans provides clarity regarding goals, communication and standardised documentation.
INFORMATION IN THE ADVANCE CARE PLAN
The information provided in the advance care plan should cover the various topic in the discussion, it should be a mix of Bob’s circumstances, willingness and participation. The information should include the benefits of ACP such as ‘when it is important to make decisions in advance or may appoint someone trusted to make decisions (Seeber et al., 2019). The provision of Do not Resuscitate order which may reduce the use of CPR and information of do not hospitalize order which is associated with reducing treatment with palliative care and hospice services are included. Information regarding substitute decision making as in if BOB wants Margret or his sons to be decision-makers for him in the future. Preferred place of care and end of life care should also be included.
Supporting documents, forms and information for advance care plan is based on The Medical Treatment Planning and Decision Act 2016 and Victoria Legislation Act, which came in effect on March 2018. These may include the “appointment of medical treatment decision-maker” form which is used if Bob wants to formally appoint decision-makers having legal authority on BOB behalf ("Forms and resources for VIC residents", 2019). “Revocation of support form and resource” for people cannot undertake Advance care planning guidelines for clinicians and consumers.
REVIEW OF THE ADVANCE CARE PLAN
The advance care plan is not a single event but an iterative process which needs to be evolved over a period of time. Review and initiation of the plan depend on various factors like circumstances, age, deterioration of the condition, preferences and decisions (Webster, 2020). As these things are prone to change the review need to be done. Subsequently, an advance care plan should be reviewed regularly to ensure the consistency and appropriateness with the goal needs and preferences for Bob. It is recommended that ACP should be reviewed if there is the presence of serious morbidity which can impact the prognosis or quality of life. Also, it should be reviewed when the individual circumstances change like the diagnosis of the new condition, death of the partner, change or substitute decision-maker and the change in the location of care. Also, it should be reviewed when a person is admitted to the hospital. If there is sudden deterioration of medical systems which results in major functions decline an advance care plan should be reviewed. If medical care for that particular disease become available or new treatment is assessable that can change the treatment plan, needs or prognosis for the patient ACP can be reviewed. if a person within the capacity switches his mind about future care or revoke formal ACP documents regarding legal decision-maker an Advance care plan should be reviewed (Ruseckaite et al, 2017).
For a patient like Bob who is suffering from a progressive illness like motor neuron disorder, Advance care plan should be discussed as earliest. In Bob’s case study due to anxiety, lack of information and non-acceptance the relevance of advance care plan becomes crucial to meet the discussion exploring what he values the most which further helps in guiding the current and future treatment and care for him. This must be challenging for both him and the family especially Margret who would be finding it demanding to take care of him. In such a situation a person centre care at the end of life should be introduced to him.