Scenario 1 Patient is entering terminal phase MST

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Scenario 1 • Patient is entering terminal phase • MST 120 mg bd •

Scenario 1 • Patient is entering terminal phase • MST 120 mg bd • sevredol 40 mg if required • metoclopramide 10 mg tds • diclofenac 50 mg tds contact: unable to take oral medication

Scenario 2 • Patient entering terminal phase • fentanyl TD 100μg patch contact: pain

Scenario 2 • Patient entering terminal phase • fentanyl TD 100μg patch contact: pain no longer controlled

Scenario 3 • • Patient with pain and nausea MST 120 mg bd sevredol

Scenario 3 • • Patient with pain and nausea MST 120 mg bd sevredol 40 mg if required cyclizine 50 mg tds • pain less well controlled, fairly constant nausea for a few days, occasional episodes of vomiting contact: family concerned that patient is suffering too much pain

Scenario 4 • Patient with advanced Ca ovary, giving partial intestinal obstruction • MST

Scenario 4 • Patient with advanced Ca ovary, giving partial intestinal obstruction • MST 120 mg bd • sevredol 40 mg if required • metoclopramide 10 mg tds • dexamethasone 4 mg daily contact: severe colicky abdominal pain in addition to background lower abdominal pain. Little nausea but intermittent vomiting

Scenario 5 • Patient commenced on MST 30 mg bd and sevredol 10 mg

Scenario 5 • Patient commenced on MST 30 mg bd and sevredol 10 mg if required 2 days ago contact: feeling sick all the time and doesn’t want to take any more morphine

Scenario 6 • Patient in terminal phase is becoming increasingly restless and agitated over

Scenario 6 • Patient in terminal phase is becoming increasingly restless and agitated over last 24 hours contact: family not coping and want situation resolved urgently

Scenario 7 • Patient with advancing disease. Condition now very poor. Increasing pain has

Scenario 7 • Patient with advancing disease. Condition now very poor. Increasing pain has resulted in 3 increases in opioid dose in last 5 days. • MST 300 mg bd • sevredol 100 mg daily • diclofenac 50 mg tds contact: confused and agitated

Scenario 8 • Patient with metastatic prostate cancer. Known to have widespread bone metastases,

Scenario 8 • Patient with metastatic prostate cancer. Known to have widespread bone metastases, but has managed to keep mobile and fairly independent. contact: recent onset of ‘new’ back pain, funny feeling in legs and finds it more difficult to get upstairs to bedroom

Scenario 9 • Patient recently discharged from Roxburghe House with epidural infusion - diamorphine

Scenario 9 • Patient recently discharged from Roxburghe House with epidural infusion - diamorphine 15 mg in 24 hours. • pain, which was initially very well controlled is once again a major problem contact: patient and family want analgesia restored

Scenario 10 • Patient recently discharged from Roxburghe House with epidural infusion - diamorphine

Scenario 10 • Patient recently discharged from Roxburghe House with epidural infusion - diamorphine 15 mg in 24 hours. • pain, which was initially very well controlled is once again a major problem contact: patient and family want analgesia restored