OET letter for a palliative care patient: wording, priorities and what to include
In an OET Nursing letter about a palliative care patient, focus on comfort and the patient's wishes: the diagnosis in one sentence, current symptoms and how they are controlled, the goals of care the notes record, what the patient and family know and want, and what the reader must do next. Use clear, respectful words such as 'palliative' and 'end of life' rather than euphemisms, and leave out curative history the reader no longer needs.
What changes when care is palliative
When a patient's care is focused on comfort rather than cure, the reader's job changes, so your selection should change too. A community palliative nurse, hospice or GP does not need the full story of past treatment. They need to know how the patient is now, what matters to the patient, and what support is needed in the coming days or weeks.
Ask of every note: does this help the reader keep the patient comfortable and follow their wishes?
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| The diagnosis and that care is palliative, in one or two sentences | Dates and details of every past treatment cycle |
| Current symptoms: pain, breathlessness, nausea, constipation, agitation, and how well each is controlled | Symptoms that are absent and not a concern |
| Current medicines for symptoms, with recent changes and as-needed use | Long-standing medicines that have been stopped and are no longer relevant |
| Function: mobility, eating, drinking, personal care | Normal observations recorded for routine purposes |
| Goals of care and the patient's wishes recorded in the notes (preferred place of care, resuscitation decision) | Your own opinions on prognosis |
| What the patient and family understand, and how they are coping | Family members not involved in care |
| Equipment and services already arranged | General information the reader already knows about palliative care |
| A clear request: visit, review symptoms, support the family | Unrelated past history |
Respectful, clear wording
Palliative letters test Genre & Style: the tone must be professional and compassionate without becoming emotional. The reader is a health professional, so plain clinical words are appropriate.
| Avoid | Prefer |
|---|---|
| "Nothing more can be done." | "Treatment is now focused on comfort." |
| "Terminal patient" | "Mrs Ahmed, who has metastatic breast cancer and is receiving palliative care" |
| "She is going downhill." | "Her condition has deteriorated over the past week." |
| "Family can't cope." | "Her husband is finding it difficult to manage her care at night." |
| "Pt for comfort care, NFR" | "She has decided, with her medical team, not to be resuscitated, and a form has been completed." (only if the notes say so) |
| "Pain bad, given lots of morphine" | "Her pain has increased, and she has needed three doses of as-needed morphine in the past 24 hours." |
Write out shorthand such as NFR, DNR, PRN and s/c. See abbreviations in OET letters.
Symptom control in sentences
The reader's first question is "is the patient comfortable?". Answer it symptom by symptom, giving the current management and how well it is working. For example:
- "Her pain is controlled with slow-release morphine 30 mg twice daily, and she has needed one as-needed dose each day."
- "Her nausea has settled since metoclopramide was started on 3 April."
- "She is breathless when walking more than a few steps but comfortable at rest."
For how to present doses, see medications in OET letters.
Worked example (invented case)
Case summary (invented): Mrs Leila Ahmed, 62, former primary school teacher. Metastatic breast cancer (liver and bone), diagnosed 2021; chemotherapy 2021–2025 (several regimens); oncology stopped active treatment in March. Admitted 20 April with uncontrolled back pain and constipation. Slow-release morphine increased from 20 mg to 30 mg twice daily; 1–2 as-needed doses daily; laxatives started, bowels opened 24 April. Eating small amounts; walks to the bathroom with a frame. Patient wishes to die at home; resuscitation decision documented with patient and husband. Husband (65) main carer, anxious about night-time care. Hospital bed and commode delivered at home. Appendicectomy 1985. Discharge home 26 April. Task: write to the community palliative care nurse.
Selection decisions:
- In: diagnosis and that active treatment has stopped, pain and bowel management with doses, function, wish to be at home, resuscitation decision, husband's role and concern, equipment arranged.
- Out: individual chemotherapy regimens, appendicectomy, former occupation.
Sample letter body:
Dear Palliative Care Nurse,
Re: Mrs Leila Ahmed, aged 62
I am writing to refer Mrs Ahmed, who has metastatic breast cancer and is being discharged home today, for ongoing palliative care and support for her husband.
Active cancer treatment was stopped in March. Mrs Ahmed was admitted on 20 April with uncontrolled back pain and constipation. Her slow-release morphine has been increased to 30 mg twice daily, and she now needs one or two as-needed doses each day. Her constipation has resolved with laxatives.
She is eating small amounts and walks to the bathroom with a frame. She wishes to remain at home for the rest of her care, and a decision not to attempt resuscitation has been documented with her and her husband. A hospital bed and commode have been delivered.
Her husband is her main carer and is anxious about managing her care at night.
I would be grateful if you could visit Mrs Ahmed soon to review her pain and support her husband. Please contact me if you require further information.
Yours sincerely,
The letter is short on history and long on what the reader must manage. Try a case like this in timed practice or check your own letter.
Mistakes to avoid
- Writing the whole cancer history. One or two sentences are usually enough.
- Euphemisms that hide meaning. The reader must understand goals of care exactly.
- Leaving out as-needed medicine use. It shows whether symptoms are controlled.
- Forgetting the carer. In home palliative care, the family's needs are often part of the request.
- Adding decisions not in the notes. Report recorded wishes; do not invent them.
See also the Genre & Style guide, social history and common OET Writing mistakes.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, doses and case notes are invented. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.