Susan is 68 years old and has been living with chronic obstructive pulmonary disease (COPD). However, she feels that her condition and quality of life has deteriorated over the last few years. She lives with her husband Tom who is her main carer. He is four years older than Susan. They have two sons and two daughters who are all married with children and live within a ten-mile radius. Susan has a good relationship with her family and finds her GP very supportive. She also receives input from the district nurse and the COPD nurse specialist.

When nearing end-of-life, while symptoms may be disease-specific, overall some of the challenges that patients and their families and carers experience can be categorised using the following domains:

• physical, pain and symptom control
• psychological, how is this patient/family/carer coping
• social, what is the support network/what is the environment
• spiritual, finding meaning, which can include finding out if there are cultural and religious considerations.