• Jane Griffiths, Gail Ewing, Charlotte Wilson, Michael Connolly, and Gunn Grande.
• School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK jane.griffiths@manchester.ac.uk.
• Palliat Med. 2015 Feb 1;29(2):138-46.

BackgroundUK 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.AimTo explore the role of District Nurses in breaking bad news of transition to dying.DesignQualitative focus groups.SettingPrimary care (District Nurse service); Four National Health Service Trusts, North West England.ParticipantsA 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.ResultsDistrict 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.ConclusionsDistrict 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.© The Author(s) 2014.

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