This article discusses health professional use of protocol in the breaking of bad news, focussing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally recommendations for practice are offered.

The administration of sedative drugs at the end of life raises both clinical and ethical challenges. This article details the evolution of sedation decision-making practices at a 14-bedded UK hospice over the course of 5 years through an initial review and two follow-up audits. Key areas, such as documented consideration of hydration status and discussion with family members, have been improved following the implementation of a checklist of decision-making prompts, demonstrating how practice can be improved and sustained over time.

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By reviewing the literature on pre-operative fasting and reflecting on the evidence base for nursing practice, this article aims to offer explanations of why nurses act contrary to evidence which suggests that their practice is outdated.

Background: Fatigue is a common symptom experienced by people with cancer and other long-term, non-malignant conditions. It can be disease-related or caused by treatments such as chemotherapy or radiotherapy. Patients frequently report this as a distressing symptom and, while some international guidelines for its management exist, evidence suggests that these are not always implemented. Method: This article reviews the evidence basis for fatigue management, looking at exercise, education, psychological interventions, complementary therapies and pharmacological therapy, and finds that a one-size fits all approach to fatigue management is unrealistic. Findings: Research appears to support different interventions at various points in the disease trajectory and this is of importance for service design as palliative care is increasingly introduced earlier in the patient's pathway. Conclusion: Although the body of research is growing, management of fatigue caused by non-malignant conditions remains poorly evidenced, making comprehensive recommendations for these patient groups even more challenging.