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

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

Scenario 3 Patient with pain and nausea MST 120mg bd sevredol 40mg if required cyclizine 50mg 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 120mg bd sevredol 40mg if required metoclopramide 10mg tds dexamethasone 4mg daily contact: severe colicky abdominal pain in addition to background lower abdominal pain. Little nausea but intermittent vomiting

Scenario 5 Patient commenced on MST 30mg bd and sevredol 10mg 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 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 resulted in 3 increases in opioid dose in last 5 days. MST 300mg bd sevredol 100mg daily diclofenac 50mg tds contact: confused and agitated

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 15mg 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 15mg in 24 hours. pain, which was initially very well controlled is once again a major problem contact: patient and family want analgesia restored