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This article presents the findings of a study that explored documentation surrounding the end-of-life care of children with cancer. An in-depth history audit of 18 children with cancer, who died from disease progression at a single tertiary paediatric centre during 1999, was performed to explore the extent and the ways in which the shift from cure to palliation was reflected in the child's medical record. The study found that while physical aspects of care were documented there was little evidence of the human-to-human aspects of care or processes of decision-making when cure was no longer a possibility. Relapse and disease progression were identified as critical junctures for families and health professionals and an important area for future research. Further, the medical records documented ill-defined periods of palliation, with the child's approaching death appearing as a gradual awareness rather than a distinct shift in goals of care from cure to palliation.

This is an abridged version of the sixth annual Robert Tiffany Lecture presented on 14 March 2001 at the Royal Marsden's National Cancer Nursing Conference in London. Robert Tiffany was the chief nurse at the Royal Marsden, London from 1976 until 1993. The lecture is named after him to commemorate his work establishing oncology nursing across the world and, more specifically, developing its practice at the Royal Marsden. This lecture examined the silences that exist in nursing practice--the things that nurses do not talk about or even understand as part of their work. Drawing on research that explored nurse-patient relationships in cancer and palliative care settings, this lecture highlighted the closeness and intimate nature of such relationships and reflected on their impact on nurses, patients and nursing practice.

Editorials by Jeanette Webber and Libby White (IJPN 2(3)) explored threats to both the nursing profession and palliative nursing as the health system faces the reality of limited resources and expanding client needs. I wish to pick up on these issues in the light of changes proposed for palliative care in one Australian state, Victoria. My central argument is that to secure the future of palliative nursing, efforts must focus on demonstrating clearly the value and contribution of nurses to client and family outcomes. Why do I think we are challenged to do this?

This article explores the ethical considerations that arose during a qualitative evaluation study of an Australian domiciliary palliative care agency. The research sought to answer the question: 'What is the relationship between palliative care philosophy and that received by dying clients and their primary carer?'. Interviews were conducted with clients, carers and agency staff, which exposed particular issues relating to the protection of vulnerable groups such as the dying. The fact that key aspects of research ethics can only be understood when the context of people's lives and experiences are taken into account is explained. Questions raised during the implementation of the study illustrate the complexity of research ethics and form the basis of the discussion.