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Communication vignettes: ‘She’s starving to death nurse!’
  1. Helen Scott
  1. Helen Scott is Editor, End of Life Care, and Staff Nurse, St Christopher’s Hospice, London, and Vicky Robinson is Consultant Editor, End of Life Care, and Consultant Nurse in Palliative Care, Guy’s and St Thomas’ NHS Foundation Trust, London. Emails: and vicky.

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It is the duty of all healthcare professionals to acquire the knowledge, skills and attitudes to communicate sensitive information to relatives (Thorns et al, 2004). According to Sykes (2004), the crucial area in relation to symptom control at the end of life is ‘preparedness’, e.g. ensuring that all appropriate drugs such as analgesics, sedatives, antiemetics and anticholinergic agents are available and prescribed to counter the symptoms that the patient may experience. However, just as essential an aspect of ‘preparedness’ is effective communication with the patient’s family and loved ones (Sykes, 2004). This article is the second in a series of fictitious communication vignettes, wherein conversations that commonly occur within end-of-life care are highlighted. The intention is to provide readers with suggestions of how to conduct difficult conversations. Individual nurses will, of course, bring their own expertise and personalities to such situations. This scenario relates to artificial nutrition and hydration which is examined in detail in the article on pages18–24 of this issue.

Case scenario

Ethel Smith is an 84-year-old woman who is in the terminal stages of secondary liver cancer with an unknown primary. She has been admitted to a medical ward in an acute hospital following a fall at home. On admission she presents with weakness and fatigue, abdominal ascites, loss of appetite and cachexia. She did not sustain specific injury from the fall, just generalised bruising to her hip. Since the death of her husband 9 months prior to this admission, Ethel has lived with her daughter, Jane. Ethel has no other children.

Jane is 59 years old. She retired early from her job as a primary school teacher to take care of her parents. Jane has no partner or children. During the first week of her admission Ethel was able to eat small amounts of a soft diet and …

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