title: Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse.
abstract: BACKGROUND
  UK District Nurses have an important role in enabling a good death. Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. District Nurses spend a lot of time with patients and families during the dying phase and are ideally placed to recognise and discuss the transition to dying.
  
  
  OBJECTIVE
  To explore the role of District Nurses in breaking bad news of transition to dying.
  
  
  METHODS
  Qualitative focus groups.
  
  
  METHODS
  Primary care (District Nurse service); Four National Health Service Trusts, North West England.
  
  
  METHODS
  A total of 40 District Nurses across the Trusts, all Registered General Nurse qualified. Median number of years as a District Nurse was 12.5. All had palliative cancer patients on their caseloads.
  
  
  RESULTS
  District Nurses' role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients' responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work.
  
  
  CONCLUSIONS
  District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK jane.griffiths@manchester.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Griffiths
authors.affiliation: Centre for Family Research, University of Cambridge, Cambridge, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Ewing
authors.affiliation: Barts & The London School of Medicine Centre for Primarly care and Public Health, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Supportive and Palliative Care, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Connolly
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
mesh_terms: D003142:Communication; D003152:Community Health Nursing / Q000193:education*; D004739:England / Q000453:epidemiology; D017144:Focus Groups; D006801:Humans; D009313:National Health Programs; D024802:Nurse's Role; D010166:Palliative Care / Q000379:methods*; D011320:Primary Health Care; D011379:Prognosis; D036301:Qualitative Research; D013727:Terminal Care / Q000592:standards*; D014342:Truth Disclosure