Advanced Care Planning: Bob case study

This case study is adapted from Bob’s s story, which you can watch here :

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 diagnosis, as in the specific pathophysiology of MND; the focus of this essay is to explore the role of advance care planning in the context of Bob’s chronic illness progression. This will require you to have an understanding of the illness trajectory of MND.

Using The Medical Treatment Planning and Decisions Act which came into effect on March, 2018

  • 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 diagnosis of MND and how it applies to the progression of his chronic illness to set the context for your discussion. To do this you will need an understanding of the illness trajectory of MND, and how the progression of the disease will impact Bob.
  • 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 headings.
  • Ensure you have clear and logical transitions between the introduction, body, and
  • 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 -peer reviewed sources is not acceptable (ie Better Health channel, Wikipedia).
  • Discuss what sort of information would be included in an advance care plan, referring to
    the Victoria specific forms which can be found here:
  • Discuss when an advance care plan would be reviewed (remembering that advance care planning is an ongoing process and people’s preferences may change over time), and when it would be activated.
  • Make sure that any statement of fact is supported by evidence, correctly referenced intext and in the reference list. When using evidence, paraphrase where possible, and always cite sources.
  • Conclude your essay by summarising, not simply restating the essay but by readdressing it considering the evidence provided. Never add any additional and new information in the conclusion!

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