Nursing — Complex Palliative Discharge to the Community Team
A palliative care ward nurse discharges a 73-year-old woman with advanced lung cancer to the community palliative care nurse. The proficient case contains a full symptom profile, a complex medication list, a family dynamic, and several incidentals. The challenge is to distil the active palliative priorities — pain, breathlessness, the anticipatory medicines — while cutting the oncology history and resolved issues.
Letter type
Discharge
Write to
Community Palliative Care Nurse
Target length
200–230 words
The case notes
Patient: Mrs Alice Brennan, 73 years old
Diagnosis: Advanced non-small-cell lung cancer (NSCLC), stage IV; palliative intent confirmed; prognostically weeks to a few months
Reason for admission: 10-day admission for pain and dyspnoea management; not for further oncology treatment
Pain: Now well-controlled on morphine sulfate immediate release 5 mg 4-hourly PRN; morphine MR 20 mg BD commenced; average 2 PRN doses per day
Breathlessness: Managed with low-dose oral lorazepam 0.5 mg PRN; fan therapy and positioning; SpO2 88–92% on 2 L O2 (comfort goal, not curative)
Anticipatory prescriptions: Subcutaneous anticipatory medicines written up and syringe driver initiated if needed: midazolam 2.5–5 mg, morphine 2.5–5 mg, haloperidol 0.5–1 mg; all available at home pharmacy
Nausea: Cyclizine 50 mg TDS — previously nausea, now settled; continue until further review
Bowels: On regular laxatives; constipation managed; stool softener and stimulant in place
Psychological: Anxious about dying at home; social worker review done; daughter is main carer; patient's expressed wish is to die at home if possible
Oncology history: Previous platinum-based chemotherapy (completed 6 months ago); two radiotherapy courses for bone metastases; immunotherapy trial (declined); multiple oncology letters in notes
Incidental: Known GORD on omeprazole; mild bilateral hearing loss (aids in situ); old right hip fracture (healed, non-operative)
Task: Write a discharge letter to the community palliative care nurse, Ms Kelly, summarising Mrs Brennan's current symptom control and the priorities for ongoing community palliative care.
Writing task
Write a discharge letter to the community palliative care nurse, Ms Kelly, summarising Mrs Brennan's current symptom control and the priorities for ongoing community palliative care.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The current pain regimen: morphine MR 20 mg BD and the PRN dose/frequency
The community nurse must be able to administer PRN doses and know when to escalate. The regimen and the average PRN use per day are the handover data that keep the patient comfortable.
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The anticipatory medicines written up, available, and the route if needed
In community palliative care, knowing that subcutaneous medicines are already prescribed and accessible is a critical safety handover. Without this, an out-of-hours nurse could not manage a crisis.
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The patient's expressed wish to die at home and her anxiety about this
The community palliative nurse's entire plan centres on supporting this wish. It is the purpose of the community referral and shapes every care decision.
Leave out
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The oncology treatment history in detail
The community palliative team is not treating the cancer. One line — advanced NSCLC, palliative intent — is the relevant context. The platinum-based regimens and radiotherapy courses do not change community care.
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GORD, hearing aids, and the healed hip fracture
Stable, unrelated to the palliative priorities. In a proficient letter, cutting these incidentals is the test. Including them signals poor selection under a word limit.
Criterion in focus · Organisation & Layout
Palliative discharge letters have a clear priority order recognised by the community team: symptom control first (pain, breathlessness), then the emergency management plan (anticipatory medicines), then the patient's goals and psychological needs. Letters organised by body system or chronologically miss this structure and lose Organisation & Layout marks.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.