The study finds a need for improved education in spirituality and spiritual care.

Clinical experience tells us that the activity of 'putting the house in order' as patients reach the terminal stage in their illness is both a common and legitimate exercise. This process can entail many activities, both physical and emotional. For example, arranging financial affairs, making a will, compiling a living will, organizing their own funeral, completing unfinished emotional business, and perhaps most importantly, pondering the very meaning of life itself. In a continual search to find innovative ways of supporting those who are touched by death and dying, this article will discuss how narrative therapeutic approaches could be helpful in supporting the family of a terminally ill patient who is 'putting the house in order'. Incorporated within this specialist area are perceptions of death and dying, theories of death and dying as well as emotions and the search for meaning. Also under review will be the evidence base for psychotherapeutic interventions, and a review of the narrative therapy approach.

Background A syringe pump is a portable battery-powered device used to deliver a Continuous Subcutaneous Infusion (CSCI), and is used in the delivery of subcutaneous medication to patients in order to optimise symptom control. A tertiary cancer centre can experience huge challenges when transferring patients to alternative care settings as the distances to be covered can be great, and the time taken for the patient to travel can be considerable. At Clatterbridge Centre for Oncology, the system for transferring patients receiving medication via a CSCI was inadequate, as the CSCI would be discontinued and the patient's symptom management could be compromised during the journey. This is especially important during end of life care when a patient is being discharged in the final few days of life. Aim To develop a process where patients could be transferred to an alternative care setting with a pump in situ in order to maintain an optimum degree of symptom control during the patient's transfer, with no disruption to medication delivery. Method Five pumps were designated specifically as transfer pumps. Documentation was designed to track the pumps and to monitor their return. A padded addressed envelope is sent with the pump for return, with accompanying details for the receiving healthcare professional regarding discontinuing the pump. Results Syringe pumps were used for the transfer of palliative care patients on 42 occasions, with 6 being used for patients who were on a rapid discharge home for the dying patient pathway. All patients suffered no disruption to medication delivery. Conclusion This innovative system of transferring patients with a syringe pump in situ to maintain an optimum degree of symptom control has been very successful. Staff found the process easy to use, and there was significant benefit to patients.

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Introduction Spiritual care is a key element of palliative care. In the UK, NICE guidelines state that spiritual care should be offered as an integral part of care. Patients should have opportunities for their spiritual needs to be assessed and it is important for those assessing need to be highly attuned to the spiritual dimension of care. However, the results from the National Care of the Dying Audit (Round 2) in the UK show that this spiritual need is still not being met. Spiritual needs can be more urgent at the end of life.