We were reliant on nurses being invited to participate in the study by a gate keeper, due to ethical committee requirements, and therefore cannot be certain that every nurse who may have been interested and able to participate received information about the study. In addition, those that took part were self selecting and it is probably the case that they had a particular interest in the topic at hand. Nonetheless, we worked collaboratively with the end-of-life facilitators who invited participants on our behalf to publicize the study and achieved participation from nurses in very diverse roles. Moreover, by holding a preliminary meeting,
we were able Inhibitors,research,lifescience,medical to gather some opinions from the participants about the key objectives we should address and were subsequently able to involve the
participants in a respondent validation exercise and in developing recommendations about the content of educational Inhibitors,research,lifescience,medical programmes for ACP. It should be noted that the focus group design may have meant that possible differences between specialist palliative care nurses (who mainly looked after cancer patients) and non specialist community nurses (who looked after cancer patients and many others) were obscured; indeed we found them to have broadly similar Inhibitors,research,lifescience,medical views and experiences. An alternative explanation for this similarity is perhaps because ACP is a relatively new concept in England. The study took place at a time when considerable policy attention in the UK was being directed towards the need to implement ACP practice in the context of a National End of Life Strategy , which was about to be published when the data were collected. In addition, a new Mental Capacity Act  Inhibitors,research,lifescience,medical had recently been introduced with provisions allowing individuals to make legally binding advance decisions to refuse treatment or to nominate a proxy for health and welfare. Together, these created a new set of circumstances for the nurses who were keenly aware of the need Inhibitors,research,lifescience,medical to develop their practice accordingly. Although most nurses had little detailed knowledge
of ACP in terms of the Mental Capacity Act, they reported that the broader Pexidartinib solubility dmso aspects of ACP, such as enabling patients to express their personal preferences for styles of care and developing relationships to facilitate communication, were an integral aspect of their practice. MRIP To this extent, ACP was seen as an opportunity to celebrate excellent nursing practice. They described a range of ways in which they used the principles of advance care planning to facilitate dialogue between patients and their families and shift the focus of clinical intervention towards palliative care. However, concerns were expressed by the nurses that these broader aspects of ACP were at risk of being overshadowed by a disproportionate concern on the part of senior managers with advance decisions to refuse treatment.