In carrying out a holistic palliative care assessment the palliative care clinical nurse specialist needs to develop the knowledge and skill of history taking and health assessment to make safe and competent decisions with patients regarding the future management of their care. This article examines this process in making a differential diagnosis with particular reference to the respiratory physical examination of a patient with a history of lung cancer using the Calgary–Cambridge Model. The model gives structure to the preparation, history taking, and physical examination (inspection, palpation, percussion and auscultation) before explaining, planning and closing the consultation, while considering the palliative patient's and family's individual wishes and goals.

Marie Donnelly - Macmillan Palliative Care Clinical Nurse Specialist, palliative care team, South West Acute Hospital, Enniskillen, Northern Ireland

Daphne Martin - Nurse Lecturer/Pathway Leader Specialist Practice in Anaesthetic Nursing and Examination Liaison Officer, School of Nursing and Midwifery, Queen's University Belfast