This paper describes the development and content of palliative care residential workshops for general practitioner/district nurse pairs from the same practice. Pre- and post-testing self-rating scales were completed by the participants of five workshops. A retrospective questionnaire identified perceived effects on practice in terms of patient and family care, and the impact of having attended with a professional colleague. Demographic data are presented followed by respondents' perceived changes in practice following the workshop. These are supported by clinical examples. Respondents were able to identify specific effects of having attended with a colleague and offered supporting examples from their practice. The difficulties and limitations in the use of self-rating scales are discussed along with the possible effects of such methods on course content and development. Recommendations are made for further study.

This is an analysis of patterns and trends in referrals and deaths in a palliative nursing service. Comparisons are made over a 10-year period and with national and district statistics. Results show numerical increases in patients referred, a trend towards medical referrals, small numbers of referrals from other professional groups and from hospitals, and death trends which are not significantly different from national statistics. Possible reasons for these patterns and trends are explored in the context of the developing Macmillan Nurse role.

Referral patterns to a palliative nursing team are examined within the context of the developing role of the service. Reasons for referral are identified and a checklist developed to encourage specificity in statement of need on referral. Comparison is made with the assessment of the Macmillan nurse on assessment. Use of the checklist encouraged greater awareness of need. There was no correlation between the referrers' perceived needs and the Macmillan nurses' assessments on visiting. The literature supports the need for more explicit referral criteria based on needs assessment. There are implications for greater awareness of roles, better communication regarding intervention, and organizational review.

No abstract

This article attempts to identify some of the reasons why patients who meet the referral criteria of domiciliary palliative nursing care services are not referred. A study was conducted among district nurses and GPs which highlighted that a 'conspiracy of silence' still existed between patients, professionals and families. A desire to manage patients themselves and a misunderstanding of the work of Macmillan nurses were also reported. Some recommendations for change are made.