The tensions of care-giving ideals and the realities of modern health systems are an acknowledged part of palliative care (Tishelman et al., 2003). The layers of complexity presented by any one client can often determine outcomes of quality of life and death and may lead to a variation of end-of-life care delivery to under-represented groups (Care Quality Commission, 2016). The community palliative care nurse specialist (PCNS) is pivotal in identifying those at risk and their issues of care, support and loss. It is not unusual for patients to report a wide range of physical symptoms, social/financial hardships, relationship issues, spiritual pain and depression (Mako et al., 2006). All of these aspects of care frequently overlap, interact and repeat through the course of the illness.