Referring patients for domiciliary care.

This article attempts to identify some of the reasons why patients who meet the referral criteria of domiciliary palliative nursing care services are not referred. A study was conducted among district nurses and GPs which highlighted that a 'conspiracy of silence' still existed between patients, professionals and families. A desire to manage patients themselves and a misunderstanding of the work of Macmillan nurses were also reported. Some recommendations for change are made.