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1. What factors influence when specialist palliative care would be helpful for people such as William and Gladys?

2. What decisions do William and Gladys need to make as William’s illness progresses?

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1. Think about the principles of palliative care that you’ve reviewed and how they can be applied to William’s situation.

What are William’s and Gladys’ main concern at this time?

How have William’s needs changed throughout his illness?

What are the key messages the GP provides in relation to William’s future care?

How did the GP communicate these messages?

How could this interaction be improved to ensure that William and Gladys get optimal support and information about the role of palliative care?

What do you think Gladys' main psychosocial needs are at this time?

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1. William said he thought he had an outside chance of living to a ‘ripe old age’ and that he doesn’t usually think much about dying.

How can these beliefs influence how he responds to a diagnosis of a potential life-limiting illness?

What societal and personal factors contributed to his beliefs? Consider in detail:

Scientific developments

Demographic changes

William’s experience with death

William’s age.

2. How can William’s cultural background influence his response to his illness?

3. In what ways would this response differ from a person who comes from a different cultural background?

4. What is your immediate reaction to William’s and his wife’s situation and their immediate and ongoing needs as a couple – and as individuals?

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William has now developed significant pain from his liver metastases and his GP has referred him to a specialist palliative care service. The specialist team keeps in close contact with the GP and his community nurse.

William and his wife are talking to the community nurse and discussing his current needs. Having assessed how he’s managing physically; the community nurse recognises that William is becoming less mobile and is increasingly fatigued.

The community nurse begins to explore with William and his wife future options for care as his illness progresses and he becomes more physically frail.

Links to PCC4U Core Module 1: Activity 11

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William's Story - William's illness progresses

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It has been one year since William’s colonoscopy showed he had stage III colorectal cancer, indicating regional lymph node involvement. Over the past year, he had a colon resection and six months of adjuvant chemotherapy. He has been seeing his GP every two months and has been attending the outpatient colorectal clinic every six months for follow up.

On his 12-month follow up, liver metastases were found. His cancer is now considered stage IV colorectal cancer. Palliative chemotherapy is available in some situations to control such advanced illness. However, William has worsening liver function and is physically too unwell to tolerate chemotherapy.

The surgeon has indicated to William that his prognosis is poor. William and his wife Gladys are seeing his GP to discuss what the oncologist from the colorectal clinic has recommended.

For further information about Colorectal cancer, access the Clinical practice guidelines for the prevention, early detection and management of colorectal cancer.

Links to PCC4U Core Module 1: Activity 8

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William is a 60-year-old man who grew up in a large family in a regional area of Australia. Over the years, like many of his generation, he has seen enormous improvements in the quality of healthcare and life expectancy. This is due to such things as the introduction of immunisation, antibiotics and new medical technology.

William has also seen how family structures have changed. He has seen:

The introduction of aged care facilities to care for frail older people who were previously cared for by their families at home.

Government changes which have supported the introduction to care and support for people affected by life-limiting illness at home, in a hospital, in a hospice and in residential aged care facilities.

Technological changes that have assisted with illness management.

Advances in medication that have resulted in people living longer with life-limiting illness.

William is concerned that he may be diagnosed with a life-limiting illness due to changes in his normal bowel habits. He has gone to his GP for advice.

Links to PCC4U Core Module 1: Activity 5