The study highlights the variable understanding of ACS and the lack of standardised assessment and management tools amongst staff in an acute hospital setting. This is likely to lead to inconsistent, and perhaps inadequate, care of patients with palliative care needs. Greater awareness and basic pathways of care may help to improve the experience of ACS for patients with cancer.

For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.

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that they felt more confident managing similar scenarios for real with three strongly agreeing. All participants either agreed or strongly agreed that the simulation study day was a realistic representation of the cases they come across in their roles, with the majority of participants strongly agreeing that the debrief was helpful. The majority of participants strongly agreed they would recommend this style of teaching to their colleagues. Free text comments were overwhelmingly positive, particularly around how realistic the scenarios were and how safe the learning environment felt. Conclusions Simulation training in emergency palliative care scenarios for specialist palliative care nurses working within the HLT is a novel, effective and well accepted method of training.