Pain in cancer patients remains common and is often associated with insufficient prescribing of targeted analgesia. An explanation for undertreatment could be the failure to identify neuropathic pain mechanisms, which require additional prescribing strategies. We wanted to identify the prevalence of neuropathic mechanisms in patients with cancer pain to highlight the need for detailed assessment and to support the development of an international classification system for cancer pain. We searched for studies that included adult and teenage patients (age above 12 years), with active cancer and who reported pain, and in which a clinical assessment of their pain had been made. We found 22 eligible studies that reported on 13,683 patients. Clinical assessment methods varied, and only 14 studies reported confirmatory testing for either sensory abnormality or diagnostic lesion to corroborate a diagnosis of neuropathic pain. We calculated that the prevalence of patients with neuropathic pain (95% confidence interval) varied from a conservative estimate of 19% (9.4% to 28.4%) to a liberal estimate of 39.1% (28.9% to 49.5%) when patients with mixed pain were included. The prevalence of pain with a neuropathic mechanism (95% confidence interval) ranged from a conservative estimate of 18.7% (15.3% to 22.1%) to a liberal estimate of 21.4% (15.2% to 27.6%) of all recorded cancer pains. The proportion of pain caused by cancer treatment was higher in neuropathic pain compared with all types of cancer pain. A standardised approach or taxonomy used for assessing neuropathic pain in patients with cancer is needed to improve treatment outcomes.

Neuropathic cancer pain is associated with a negative impact on daily living and greater analgesic requirements than nociceptive cancer pain. Validated assessment methods are needed to enable early identification of neuropathic cancer pain, leading to more appropriate treatment and reduced burden on patients.

Despite positive staff attitudes towards corneal donation, many barriers to discussing donation were identified, which may reduce donation rates. This could be improved by local policies encompassing further education, prompts in documentation and availability of leaflets.

This is the first study to engage directly with palliative care patients and to establish their views on the timing of corneal donation discussions. Patients are willing to discuss donation, and further exploration of patient views in this area should be undertaken.

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Introduction Various national strategies and standards in end of life care emphasise that generalists should identify those in the last year of life, and be able to have advance care planning (ACP) discussions with these patients. We identified that local clinician's lack confidence in doing this. Aim(s) and method(s) Our aim was to increase confidence in discussing advance care planning (ACP). We delivered 3 hour long education sessions to senior doctors and nurses in the hospital and community using role play with actors. The hospital videoed the role play in a dedicated simulation suite. Pre and post course questionnaires on confidence in communication were completed. Results There were 3 hospital sessions to 9 senior doctors and 8 senior nurses, and 5 community sessions to 31 senior nurses and 11 GPs. Confidence across all domains improved post course. On average those community clinicians who rated their confidence as good or very good rose from 25.5% to 50.7% and the hospital clinicians from 37.4% to 76.7%. The hospital clinicians rated themselves as more confident than community clinicians in 3 questions before the course and in all domains after the course. Conclusion(s) All clinicians improve their confidence in discussing ACP after the course. On average hospital clinicians were more confident both before and after the course. Different teaching environments may account for some of this but conclusions are limited by the different numbers in each group. Those delivering ACP communication sessions should consider potential differences in confidence between the 2 groups and adapt sessions accordingly.

Background There is little literature available regarding the use of radiology services within the hospice setting. St Gemma's Hospice in Leeds has a 32-bed inpatient unit with around 600 admissions per annum and a day unit and outpatient service reviewing 400 patients a year. It accesses the local hospital trust for imaging. Aims To collate all radiology requests over a year to determine the frequency of different imaging modalities and what proportion detected the anticipated result or an alternative explanation for symptoms. Secondary aims included the proportion of patients who died within 2 weeks of imaging and examining the cost of imaging. Method Data were collected retrospectively from the radiology IT department at Leeds Teaching Hospitals NHS Trust. It included details of all imaging requested for inpatients and outpatients between 1/1/10 and 31/12/10 by Doctors within the hospice. Results 51 patients had 62 scans: 21 CTs, 18 MRIs, 10 Ultrasound scans, 4 CXRs, 4 AXRs, 3 Nuclear bone scans and 1 barium swallow. The most common reasons for imaging were for possible brain metastases (13), or spinal cord compression (12), 29% and 25% respectively were positive. Imaging for venousthromboembolism (11), and disease progression (6), were the next most common reasons for scanning, 27% and 67% respectively were positive. Scans showed an explanation for symptoms in 5/12 (42%) for SCC, 5/13 (38%) for brain mets, 5/5 (100%) for PE and 5/6 (83%) for disease progression. 11% of patients died within 2 weeks of having their scan. The approximate total cost based on NHS average reference costs was just under £10,000. Conclusion Most scans were appropriately requested. Depending on the imaging between 25 and 100% showed some abnormality. Most imaging was avoided in the 2 weeks prior to a patient's death. The costs associated with imaging are significant.

Patients die in hospital every day, some receiving suboptimal care. This article focuses on the care of these patients in their last days specifically discussing medication review, symptom control, assisted nutrition and hydration, spiritual and religious needs, and documentation.