title: End of life care: a discursive analysis of specialist palliative care nursing.
abstract: OBJECTIVE
  The aim of this paper is to consider alternative approaches to service delivery for patients with chronic life-limiting illnesses other than cancer. It will also discuss the issues that arise when considering specialist palliative care services within a broader public health context in the United Kingdom.
  
  
  BACKGROUND
  Contemporary specialist palliative care in the United Kingdom can be said to have two main client groups: the majority are people with a diagnosis of cancer, and a minority are those with a number of other chronic illnesses. From the evidence to date, patients dying from chronic, non-malignant disease experience a considerable number of unmet needs in terms of symptom control and psychosocial support. Although debates in the literature over the last decade have challenged the focus of specialist palliative care services on patients with a cancer diagnosis, only a minority of those with other chronic illnesses receive specialist palliative care services.
  
  
  CONCLUSIONS
  Current models of specialist palliative care may not be the most appropriate for addressing the complex problems experienced by the many patients with a non-cancer diagnosis. We suggest that care should be structured around patient problems, viewing specialist palliative care as a service for those with complex end of life symptoms or problems. A role for innovative nurse-led care is proposed.
  
  
  CONCLUSIONS
  Reframing the approach to specialist palliative care in the United Kingdom will require great effort on the part of all health and social care professionals, not least nurses. Critical and creative thinking are prerequisites to the development of new models of working. We suggest that a more coherent approach to research and education is required, in particular strategies that explore how patients and nurses can work together in exploring experiences of illness in order to develop more proactive approaches to care.
authors.affiliation: School of Nursing and Midwifery, University of Sheffield, Sheffield, UK. j.k.skilbeck@sheffield.ac.uk
authors.forename: Julie K
authors.initials: JK
authors.lastname: Skilbeck
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
mesh_terms: D002908:Chronic Disease; D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends; D004506:Education, Nursing / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006801:Humans; D009732:Nursing Care / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D011634:Public Health; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill; D006113:United Kingdom