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Michelle is a 38-year-old woman who lives with her partner, Pete. They have two children aged 9 and 12. Michelle was diagnosed two years ago with triple negative breast cancer, a particularly difficult cancer to treat as it is negative for oestrogen receptors, progesterone receptors and HER2.

She had initial treatment but has recently been experiencing a nagging cough and slight breathlessness. Michelle goes to her GP to explore her concerns.

Links to PCC4U Core Module 2: Activity 2

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Michelle’s CT scan shows that her cough is caused by the spread of the cancer to her lungs. She also has evidence of metastases in her liver.

She attends an appointment with Dr Meredith North, her medical oncologist. Meredith explains the significance of these results and what they mean for Michelle’s prognosis and further treatment.

Links to PCC4U Core Module 2: Activity 3

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Michelle's Story - Receiving Distressing News

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Video 3: Understanding palliative treatment

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Video 3: Understanding palliative treatment

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Michelle requires care from multiple care providers.

Her bone scan identifies that she also has metastatic deposits on her spine which causes her back pain. Following these results Michelle’s medical oncologist referred her to the radiation oncologist and a plan for palliative radiation therapy has been put into place.

Michelle attends her planning appointment at the radiation therapy department. She sees Jeremy Peters, the radiation therapist, who responds to her questions about palliative radiotherapy. He orientates her to the radiation therapy department and the different types of equipment used in the planning process and the delivery of radiation therapy.

Links to PCC4U Core Module 2: Activity 6

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Michelle's Story - Understanding Palliative Treatment

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Michelle is receiving her palliative chemotherapy in the day chemotherapy unit. Dawn Matthews, the cancer nurse coordinator, visits the unit to see how Michelle and Pete are going. Michelle and Pete raise concerns about telling their children that Michelle’s illness is deteriorating. Dawn works through these concerns with them and suggests strategies to help them address these concerns.

Links to PCC4U Core Module 2: Activity 8

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1. What are some of the fears and concerns that Michelle is experiencing at this time?

2. What are your immediate personal reactions to Michelle’s situation? Consider why you might be reacting in this way?

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1. What are the main sources of distress for Michelle and Pete at this time?

2. How aware of her symptoms and possible diagnosis does Michelle appear to be?

3. What specific communication strategies did Meredith use to provide the news to Michelle and Pete about the progression of her illness?

4. What additional communication strategies could the oncologist use to improve this interaction?

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1. What are the main sources of distress for Michelle at this time?

2. What specific communication strategies did Jeremy use to help Michelle understand her treatment?

3. What additional communication strategies could Jeremy use to improve this interaction?

4. What communication strategies should Jeremy use to achieve coordinated care?

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1. Watch the video and answer the following questions:

What are the main concerns that Michelle and Pete have about discussing Michelle’s prognosis with their children?

What specific suggestions did Dawn provide to assist Michelle and Pete?

What communication strategies did Dawn use to provide this advice?

What additional strategies could Dawn use to improve this interaction?

2. What are the main issues for children when a parent has a life-limiting illness?

3. How will these concerns vary depending on the child’s age?

4. How would you respond to a parent who is concerned about the effect of their illness on their child/ren?

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Paramedics were able to assess Michelle and provide support for Pete in continuing to manage her care at home. She died the following day with Pete and the family at her bedside.

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Michelle attends a follow-up appointment with Dr Meredith North, her medical oncologist. She has completed her radiotherapy and has commenced palliative chemotherapy. She is exhausted and looks unwell.

She is symptomatic with breathlessness and expresses her concern about this. Meredith assesses her breathlessness and develops a management plan with Michelle and Pete. As part of this plan, she introduces the concept of palliative care.

Links to PCC4U Core Module 2: Activity 7

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Michelle's Story - Michelle's Illness Progresses

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1. What are the main sources of distress for Michelle and Pete at this time?

2. What specific communication strategies did Meredith use to:

Respond to Michelle’s distress?

Introduce the concept of palliative care?

3. What additional communication strategies could the oncologist use to improve this interaction?

4. Access the CareSearch factsheet “Introducing specialist palliative care services”.

Review the examples of useful phrases and consider how you can use them in your role.

Are there other phrases you have found helpful when communicating about palliative care?

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It has been a few months since Michelle was given the news that her cancer had progressed. She has been receiving palliative chemotherapy to help control her illness but is finding that her personal and social relationships are changing.

She has requested an appointment to see Dawn Matthews, the Cancer Care Coordinator, as she is feeling lethargic and worried about how she is coping. Dawn arranges for Michelle to see her prior to her scheduled chemotherapy.

Links to PCC4U Core Module 2: Activity 10

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1. Review items within the Patient Dignity Inventory to identify some of Michelle’s sources of distress at this time.

2. What communication strategies does Dawn use to encourage Michelle to talk about her concerns?

3. As a healthcare professional, what can you do to help a person like Michelle to feel in control when their illness is progressing?

4. Dawn asks Michelle if she would be interested in seeing a psychologist for support. In what circumstances should referral to a psychologist be considered?

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Michelle’s illness is progressing and she acknowledges that she is dying. James Smith, the palliative care nurse, has been asked to visit Michelle and Pete at their home to review what support they need in preparing for end of life. During the visit, Michelle talks with James about what dying means and what is important to her at this time. Michelle starts to explore what will happen when she dies.

Links to PCC4U Core Module 2: Activity 11

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Michelle's Story - Spiritual Conversations

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1. What does Michelle state is important to her at this time?

2. What specific strategies does James use to explore the meaning of illness and dying to Michelle?

3. What specific strategies does James use to respond to:

Michelle’s question: ‘I am going to die soon, aren’t I?

Michelle’s questions about dying?

4. What other strategies would you recommend to:

Explore the meaning of illness and dying to Michelle?

Respond to Michelle’s questions about dying?

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Michelle’s condition has deteriorated and she is now dying. She is being cared for at home and is now in bed all the time, semi-conscious. James is visiting the family at home.

Pete and James discuss Michelle’s imminent death. James prepares Pete and the family around the process of dying and what to expect. He offers ongoing support from the palliative care team at this time and into the bereavement phase.

Links to PCC4U Core Module 2: Activity 14

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Michelle's Story - Preparing for Michelle's Death

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1. What are Pete’s main concerns at this time?

2. How does James help Pete deal with these concerns?

3. What other strategies would provide emotional support to Pete, Michelle and their family at this time?

4. What simple terms did James use to help describe the terminal phase and how could he have improved his interactions?

5. These conversations can be difficult for health professionals. Consider how you would respond if you became emotional or teary when communicating in such a circumstance.

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Audio: Pete calls 000 for help in managing Michelle's pain

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Audio: Pete calls 000 for help in managing Michelle's pain

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Michelle has not been out of bed in the past week and is minimally responsive. After turning her in bed, Michelle’s husband Peter calls 000 because he is worried that Michelle has increased pain as she groaned loudly. Unfortunately, the palliative care team is not available after hours. Listen to the audio of the 000 call to hear the exchange of information between Peter and the Emergency Medical Dispatcher.

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Michelle's Story: Pete calls 000 for help in managing Michelle's pain

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1. Describe your first reactions after listening to the audio of the call – what did you notice, how did you feel, what felt right/wrong to you?

2. If you were the paramedics responding to this call, what additional information would you ask for and what would you be thinking about, what are the priorities in this situation?

3. What are the first things that you do when you arrive?

4. In your conversations with Pete how would you show empathy?