Community palliative care clinical nurse specialists (commonly known as Macmillan nurses) play an important role in specialist palliative care (Skilbeck et al. 2002). They spend time with patients and their families, helping them come to terms with an array of complex emotional and practical problems, facilitating communication, giving information and advice about treatments and also offering expertise in controlling pain and other distressing symptoms. These nurses are equipped with specialist skills to assess the complex palliative care needs of patients referred to the service. However, Bliss et al. (2000) found that referral to services is dependent upon the individual who initiates it and, although unintentional, may result in a form.
