Case Study Report liver cancer

Case Study Report

Patient Care Action Plan for: William

Main Contact: Gladys

Main Contact’s Relation to Client: Wife

Council area where client lives:  London

Client Address: 49 Featherstone Street, London, United Kingdom

Background

This patient care action plan is for William. William currently has liver cancer and he is very much worried about his condition and how his wife Gladys will cope with the situation. When William was growing up, he thought that he would live to reach ninety years old, like his parents, without any serious illness. His dream of living longer has just been shattered after he recently discovered the presence of blood in his stool. On visiting the hospital, William has received a confirmation from Dr. Maxwell that he has liver cancer. William’s immediate carer is his wife, Gladys, who provides assistance with daily living activities as well as with social support. Since William’s kids have their own families and they are mostly committed to work, he has limited access to family support. His living setting is the home environment, and he frequently visits the hospital from where he is cared for by Dr. Maxwell and nurse Linda. Dr. Maxwell has involved other physicians in William’s care. The doctor is working together with other highly qualified healthcare professionals to ensure that William receives the support that he needs for the longest period possible. William’s health condition is not that severe, and his recent health care trajectory indicates that he has a positive progress. His positive health progress is mainly attributed to good communication and a positive relationship with his healthcare providers, including the social worker. At the moment, William largely depends on services obtained from only one GP healthcare resource. 

Needs Assessment

From the PCC4U Needs Assessment, it is evident that some of Williams needs have been met while there are others, which have not been effectively addressed.

Needs that are currently met

 The positive progress that is being observed in the patient is attributed to primary health care services that he is now receiving from the doctors and nurse Linda (Llobera, Sanso, and Leiva, 2017). Through support obtained from the doctors, William has learned and can apply various health promotion options that are available to him. Also, William has been informed about the right people he should approach in case his health condition gets worse. 

Immediate needs that should be met

It is important to prioritize patients’ unmet needs to plan effectively on how to help them manage their health conditions (Khosla, Patel, and Sharma, 2012). There are two major immediate needs that William should be assisted to meet. During his interaction with nurse Linda, William explains that he is in a bit of pain and that he still has a lousy appetite. These conditions are common among older people with terminal illnesses (Goodman, Dening, and Zubair, et al., 2016). In this regard, William should be taught how he can solve his appetite problems and how he can effectively manage pain.

Potential needs that might arise

William’s healthcare providers should be prepared to address potential needs that might arise in the course of care. It is important to identify possible emotional and physical health problems that may arise to formulate strategies that can be used to prevent them early (Clarke, Bourn, Skoufalos, Beck, and Castillo, 2017). To meet William’s physical and emotional needs, the healthcare providers should engage specialists in palliative medicine and palliative nursing, as well as family members, to provide necessary care as early as possible (Llobera, Sanso, and Leiva, 2017). 

Local Resources and Services Scan

Service name and brief description

Address/contact details and website URL (if available)

Opening hours/contact hours

How to access (e.g. is a referral required?)

What needs can this service help to meet?

Healthcare team member responsible for referral/action

Additional Comments

Companions of London_110 Gloucester Ave,

London NW1 8HX,

+44 020 3519 8001

www.companionsoflondon.com/palliative-care

Every day: 9.00 am to 5.00 pm.

Closed on Saturday and Sunday

No referral required

Primary care, including emotional and social support.

Palliative nurses are available even with short notice.

This is a useful back up for William’s primary care and emotional and social support needs.

St. Joseph’s Hospice

Mare St, London E8 4SA,

+ 44 020 8525 6000

8.30 am to 5.00 pm every day

Referrals are necessary.

From 8.00 am to 6.00 pm every day by calling 0300 30 30 400.

Provides all primary care services needed by patients with serious illnesses. 

Sharon Finn offers social services support and can connect patients with palliative care specialists in the facility.

This facility provides hospice care that William may need shortly.

Meadow House Hospice

Uxbridge Road, Middlesex, UB1 3HW

+44 020 8967 5179

Open Monday to Friday from 8.30 am to 5.00 pm, Saturday from 12 pm to 2.30 pm, Closed on Sunday.

Referrals are required.

From Friday 8.30 am – 16.00 pm by calling 020 8967 5758

Psychiatric and primary care services.

Jane Cowap is the lead clinician who specializes in psychiatric care for geriatric patients.

This facility will be appropriate for William in future when he will be in need of psychiatric support.

Pembridge Palliative Care Unit

Exmoor St, London W10 6DZ, UK

+44 20 8102 5000

Open 24 hours daily

No referral required

Psychological and physical support.

Doctor Louise Ashley specializes in the treatment of psychological problems, especially for patients with physical disabilities.

A useful facility for screening and diagnostic procedures.

Marie Curie Hospice, Hampstead_11 Lyndhurst Gardens, Hampstead, London NW3 5NS, UK.

+44 20 7853 3400

Open Monday to Friday from 8.00 am to 6.00 pm, Saturday 11.00 am to 6.00 pm, and Closed on Sunday

No referrals are necessary

Offers emotional and social support for patients with terminal illness and their families.

Lead nurse Angel and Marilyn can assist patients with making appointments and follow-up.

William can get necessary emotional and social support from this facility.

Hospice UK_34-44 Britannia St, Kings Cross, London WC1X 9JG

+44 20 7520 8200

Open Monday to Friday from 9.00 am to 5.00 pm, Closed on Saturday and Sunday

No referrals are necessary

Provides all types of home-based care needed by patients with serious illness.

Carol Warlford is the Chief Clinical Officer in charge of all forms of palliative care in the facility.

This facility is appropriate for meeting William’s physical, social, physiological, and emotional needs both now and in future.

St. Christopher’s Personal Care_Sydenham, UK

+44 20 8768 4500

Open every day from 9.00 am to 5.00 pm.

No referrals are required

Offers support with all forms of care including medication, nutrition, activities of daily living, social support, and emotional support.

Denise, Maxine, Tony, and Sandra are highly trained to offer palliative care to all patients with various needs.

The facility is a useful back up for William’s palliative care needs.

Action Plan

Medication: The nurse should plan a visit to the physician to provide the right prescription for William to enable him to manage pain effectively (Ramanayake, Dilanka, and Premasiri, 2016; & Al-Mahrezi, and Al-Mandhari, 2016).  This arrangement should be made as soon as possible. 

Nutrition: The nurse should contact a nutritionist to help with the development of a feeding plan for William and his wife. Since appetite is one of William’s problems that should be solved urgently, this action should be started as soon as possible (Forbat, Haraldsdottir, Lewis, and Hepburn, 2016; & Caccaialanza, Pedrazzoli, and Zagonel, et al., 2016).

Physical Activity: William’s wife should contact a trainer to help William with physical exercise (Lowe, Tan, Faily, Watanabe, and Courneya, 2016; & Chandrasekar, Tribett, and Ramchandran, 2016). This arrangement should be made before William’s next meeting with the GP.

Counselling: The nurse should plan a visit to a professional psychologist to plan counselling sessions for William and his family (Pino, Parry, Land, Faull, Feathers, and Seymour, 2016). This plan should be ready before William’s next meeting with the GP.

Referral to Hospice: The nurse should contact a social worker to provide William and his wife with detailed legal information related to the procedures he should follow when he will be required to relocate from home-based care to the hospice (Hui and Bruera, 2016). This arrangement should be made when William will no longer be in a position to make decisions by himself.

Reference List 

Al-Mahrezi, A. & Al-Mandhari, Z. (2016). Palliative care: Time for action. Oman Medical Journal, 31(3): 161-163. doi:  10.5001/omj.2016.32

Caccaialanza, R., Pedrazzoli, P…& Zagonel, V. (2016). Nutritional support in cancer patients: A position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). Journal of Cancer, 7(2): 131-135. doi:  10.7150/jca.13818

Chandrasekar, D., Tribett, E. & Ramchandran, K. (2016). Integrated palliative care and oncologic care in non-small-cell lung cancer. Current Treatment Options in Oncology, 17: 23. doi:  10.1007/s11864-016-0397-1

Clarke, J., Bourn, S., Skoufalos, A., Beck, E. & Castillo, D. J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1): 23-30. doi:  10.1089/pop.2016.0076

Forbat, L., Haraldsdottir, E., Lewis, M. & Hepburn, K. (2016). Supporting the provision of palliative care in the home environment: A proof-of-concept single-arm trial of a palliative carers education package (PrECEPt). BMJ Open, 6(10): e012681. doi:  10.1136/bmjopen-2016-012681

Goodman, C., Dening, T…& Zubair, M. (2016). Effective health care for older people living and dying in care homes: A realist review. BMC Health Services Research, 16: 269. doi:  10.1186/s12913-016-1493-4

Hui, D. & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology, 13(3): 158-171. doi:  10.1038/nrclinonc.2015.201

Khosla, D., Patel, F. D. & Sharma, S. C. (2012). Palliative care in India: Current progress and future needs. Indian Journal of Palliative Care, 18(3): 149-154. doi:  10.4103/0973-1075.105683

Llobera, J., Sanso, N….& Leiva, A. (2017). Strengthening primary health care teams with palliative care leaders: Protocol for a cluster randomized clinical trial. BMC Palliative Care, 17: 4. doi:  10.1186/s12904-017-0217-9

Lowe, S., Tan, M., Faily, J., Watanabe, S. & Courneya, K. (2016). Physical activity in advanced cancer patients: A systematic review protocol. Systematic Reviews, 5: 43. doi:  10.1186/s13643-016-0220-x

Pino, M., Parry, R., Land, V., Faull, C., Feathers, L., & Seymour, J. (2016). Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE 11(5): e0156174. https://doi.org/10.1371/journal.pone.0156174

Ramanayake, R., Dilanka, G. & Premasiri, L. (2016). Palliative care: Role of family physicians. Journal of Family Medicine and Primary Care, 5(2): 234-237. doi:  10.4103/2249-4863.192356

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