As a Clinical Social Worker who has been in a medical setting for the last seven years, I am often working with people facing the difficult task of planning. We are usually planning as a result of illness or loss of functioning due to multiple medical issues. The types of decisions vary and are individual to each person (and family); they can include medical/treatment decisions, housing decisions, and financial decisions. This process can be overwhelming in the best of circumstances. I encourage patients and families to begin discussions around planning early and continue them throughout life, as our ideas, values, and decisions may change over time.

Advance Care Planning typically involves three major steps –

1. Setting Goals of Care (consider goals of care keeping longevity, function, and comfort in mind – consider treatment options as they relate to these goals)

2. Communicating Choices (be sure that people most likely to be involved in treatment are aware of choices – have conversations and discussions about choices and rationale behind them)

3. Documenting Choices (advance directives are most commonly used – advance directives involve appointing someone to make medical decisions for you if/when you are no longer able to do so and documenting your wishes so that providers/family can make decisions and provide treatment that matches your beliefs/values - other options may be used depending on individual needs, wants, and state you reside in)

I have encountered several challenges to getting started. People are reluctant to face mortality and possibility of illness or death. People vary in their ability and willingness to consider abstract thoughts. People are concerned about the impact of discussions of death on others. Research has found that the two biggest fears people have when facing illness and death are dying alone and pain/suffering. Often starting these conversations and making these difficult decisions can ease the burden both of the individual and of the family.

Things to consider when thinking about planning:

• Financial Issues – contact hospital financial counselors, insurance companies, local financial assistance resources, etc.

• Housing/Living Arrangements – current and future needs, plan for increased need of support services, hospice, etc.

• Advance Directives – complete Advance Directives, Living Will, and/or Durable Power of Health Care depending on needs, wants, and requirements of individual state

• Legal Issues – consider completing a Will, Trust, Legal Power of Attorney, or other options as needed

• Put Your Affairs in Order – organize records, documents, insurance policies, financial documents, etc. – ensure family members know how to access information and your wishes

• Memories – talk about ways you would like to be remembered and prepare; these could include a journal, photo books, video, memorial service, or anything that leaves behind your personal legacy

As always, you are not alone. There are many resources available to assist you in this process.

Approximately 600 Australians are diagnosed with malignant mesothelioma each year, yet not all of them have the same access to necessary treatment and palliative care.

A new report by the Allen Consulting Group has found "extreme inequalities" in the treatment access experienced by mesothelioma patients in different parts of Australia, particularly access to the drug Alimta. The report, commissioned by the Asbestos Diseases Foundation and drug manufacturer Eli Lilly, maker of Alimta, shows that only half of Australians suffering with mesothelioma have access to the drug which has been shown to reduce pain and prolong life by 2-3 months. According to the report, approximately "30 to 50 percent of the mesothelioma patients who would benefit from a course of Alimta experience problems obtaining subsidized or compensated access to the treatment."

The report demonstrated a huge variation in subsidized access among different Australian states. Specifically, government subsidy programs are currently in place in New South Wales and Western Australia, but none exist in the states of Victoria, South Australia, Queensland and Tasmania. In addition, access to appropriate treatment may vary depending on the location and manner of exposure to asbestos, and whether that exposure can be proven. The result is that some patients in NSW are receiving fully subsidized chemotherapy treatments while up to 400 other patients in other parts of the country are not. For those mesothelioma sufferers who are not receiving treatment subsidies, it can cost upwards of $20,000 for each cycle of treatment.

Barry Robson, president of the Asbestos Diseases Foundation hopes that the newly released report will move the Federal Government to add Alimta to the Pharmaceutical Benefits Scheme, increasing access for mesothelioma victims. The drug is currently listed for the treatment of non-small cell lung cancer, but has not been approved for mesothelioma funding on the grounds that it is not "cost effective".

Some of you may be interested in the documentary being aired on PBS 8/28/2007. The special is called P.O.V. (Point of View) – it tells the story of Libby, Montana and the asbestos exposure that took place there. Here is the link to the PBS Website for additional information.

EVERETT, WA/August 27/--A Washington State Court of Appeals set an important precedent recently in an asbestos case against Kimberly-Clark when it ruled that the employer had a duty to protect a worker's family as well as the worker against injury from "an unreasonable risk of harm it had itself created", overturning a previous ruling of a Snohomish County judge who found that the duty to foresee the dangers of asbestos did not extend to the worker's family members. The Appeals Court ruling gives hope to hundreds of family members of asbestos workers who have suffered harm from exposure to deadly asbestos fibers brought home on the workers' clothing; they now have the right to file suit and have their cases heard by a jury. According to statistics compiled by the EWG Action Fund analysis of Government Death Data, Washington state ranks 8th for highest number of mesothelioma deaths in the country.

The Appeals Court ruling was particularly good news for Larry Rochon, who brought the underlying action for negligence against Kimberly-Clark on behalf of his wife Adeline Rochon, who was diagnosed with mesothelioma in 2004 and died in May 2006. Rochon alleges that his wife's illness was caused by her exposure to asbestos fibers he brought home with him from his job at the Scott Paper Company. Rochon worked at the Everett paper mill for nine years in the 1950's, during which time he helped pipefitters on lines insulated with asbestos and worked on rigging cranes hauling rolls of paper, also around asbestos. According to Rochon, his wife regularly washed and shook out his clothing which was full of asbestos dust he unwittingly brought home with him from work. Kimberly-Clark purchased the Scott Paper Co. in 1996 and has thereby assumed its legal responsibilities. It is not known at this time whether Kimberly-Clark plans to appeal this decision to the state Supreme Court.

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Well known Australian asbestos activist Bernie Banton announced on Tuesday that he has been diagnosed with peritoneal mesothelioma, a deadly cancer that attacks the lining surrounding the abdomen. Banton, a former James Hardie Industries employee (he worked at a Hardie insulation plant from 1968-1974), had been suffering from asbestoses and asbestos-related pleural disease since 1999. At that time he received compensation for his injuries in an undisclosed amount, but did not agree to a full and final settlement.

In 2004 Banton became publicly involved in the successful fight to set aside additional compensation for future asbestos claimants when it became known that the funding set aside by building materials giant James Hardie was insufficient and would be depleted in three years' time. Recently, Banton has been active in the fight to have the mesothelima drug Alimta listed on the Australian Pharmaceutical Benefits Scheme (PBS), which would make it more accessible to those who need it. Banton has pledged to keep on fighting, only now it's personal. On Monday he filed a compensation claim with Australia's Dust Diseases Tribunal and may end up benefiting from the new fund he fought to have set up. "I will fight [James Hardie] to my dying breath to ensure my family will be OK once I am gone," Banton said in a statement. "I also intend to fight pretty hard to live!"

For more information, click here.