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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please manage the patient’s request as appropriate. Physical examination and investigations are not required.

Scenario

Liz Ross is 81 years old and a regular patient of yours. She has recently been diagnosed with metastatic ovarian cancer and her treatment is supportive rather than curative. She is currently feeling quite well physically and is pain free. Liz has come in to see you today because her daughter has told her to ‘get her affairs in order’.

The following information is on her summary sheet:

  • Past medical history

  • Ovarian cancer

  • Mild hypertension

  • Medication

  • Paracetamol 1 g qid (antihypertensive stopped after cancer diagnosis)

  • Allergies

  • Nil

  • Immunisations

  • Influenza and pneumococcal vaccinations up-to-date

  • Social history

  • Widowed, four children; lives with her eldest daughter, Rosie

  • Non-smoker

  • Does not consume alcohol.

INSTRUCTIONS FOR THE PATIENT, LIZ ROSS

Your opening statement is ‘As you know doctor my days are numbered, my daughter thinks I should get my affairs in order and talk to you about paperwork.’

You are an 81-year-old woman with recently diagnosed ovarian cancer. Your treatment will not cure your cancer but aims to keep you comfortable. At the moment you feel very well and live independently. You have limited health literacy and don’t understand the legal or practical aspects of advance care planning. You don’t need anything else today as you saw your specialist yesterday.

You have come to terms with your diagnosis and feel satisfied that you’ve lived a long and good life. You are not depressed and don’t have any questions regarding your prognosis or treatment at this time.

You have heard there is a form that will stop hospital doctors ‘giving you the paddles’ if your heart stops. You think this is a reasonable idea, as you don’t want to prolong your life if you are very ill with little chance of recovery.

Your understanding from what your daughter has told you, is that these forms will mean you don’t have to make any future decisions, handing over the management of your health and financial affairs to your daughter. While this appeals in one sense, and you trust that your daughter will act in your best interests, you also feel like you would like to have a say in what happens while you still have your faculties and feel less comfortable with signing something that hands over decision-making at this point.

You have a simple will, leaving your estate to your children and your grandchildren and you are happy with that.

Initially answer questions about your understanding with a hesitant ‘yes’; however, if asked to explain in your own words or for other appropriate assessments of understanding, you respond in a way that shows your understanding is very limited. ...

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