title: Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care.
abstract: OBJECTIVE
  The aim of the research was to explore specialist cancer and palliative care nurses experience of delivering significant news to patients with advanced cancer.
  
  
  METHODS
  A qualitative phenomenological research study was conducted to capture nurses' experiences with the aim of understanding how cancer and palliative care clinical nurse specialists work towards disclosure of advanced and terminal cancer. Data were collected through semi-structured interviews with 10 clinical nurse specialists working in one acute NHS trust. Clinical nurse specialists were recruited from the following specialities: lung cancer, breast cancer, gynaecological cancer, upper and lower gastrointestinal cancer and palliative care.
  
  
  RESULTS
  Four themes emerged from the data: importance of relationships; perspective taking; ways to break significant news; feeling prepared and putting yourself forward. The findings revealed that highly experienced clinical nurse specialists (CNSs) felt confident in their skills in delivering significant news and they report using patient centred communication to build a trusting relationship so significant news was easier to share with patients. CNSs were aware of guidelines and protocols for breaking significant and bad news but reported that they used guidelines flexibly and it was their years of clinical experience that enabled them to be effective in disclosing significant news. Some areas of disclosure were found to be challenging in particular news of a terminal prognosis to patients who were of a younger age.
  
  
  CONCLUSIONS
  CNSs have become more directly involved in breaking significant news to those with advanced cancer by putting themselves forward and feeling confident in their skills.
authors.affiliation: Macmillan Palliative Clinical Nurse Specialist, Kingston Hospital Foundation Trust, Surrey, KT2 7QB, UK.
authors.forename: Nina
authors.initials: N
authors.lastname: Mishelmovich
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK. Electronic address: a.arber@surrey.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Arber
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK.
authors.forename: Anki
authors.initials: A
authors.lastname: Odelius
mesh_terms: D005260:Female; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D009720:Nurse Clinicians; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009859:Oncology Nursing; D057184:Practice Patterns, Nurses'; D014342:Truth Disclosure