“Aims:To understand the importance of patients values and wishes being recognised in palliative care. To examine the role of family in end-of-life decision-making. To evaluate the role of a specialist palliative care service in end-of-life care of older people.
Concepts:Values wishes family decision-making specialist palliative care services quality of life.
Case study: Beryl is an 85 year old woman living alone in own home. Beryl has end stag heart failure non-insulin diabetes osteoarthritis and cataracts. She has three daughters one who lives in the same city the other two love interstate (3 hours flight away). Beryl is receiving a Home Care Package Level 3 which provides assistance with some activities of daily living. assistance with meal preparation and medication administration. This package is administered by a church based non-government provider. Beryl chose this provider as it has links with her local parish church where she has been a member all her life.
Beryls GP who has been involved in her care for many years has recently suggested to her that she should make sure her affairs are in order including ensuring her family understands her wishes. While the GP could not put an exact time frame on how long Beryl has to live he did indicate a possible six to 12 months prognosis. Beryl is unsure about putting things in writing and wonders why her three daughters cant just do the right thing when the time comes.
Read and reflect on the case and answer the following questions:
1. Using a strengths-based approach what are the steps that you would undertake to ensure that Beryl has her values and wishes respected by her family and health professionals involved in her care?
2. What role does Beryls family play in helping her make decisions or following those that she might want?
3. What role would a specialist palliative care service play in Beryls care now and in the future?
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