OET Writing practice · Nursing
Advanced lung cancer symptom control – community palliative care
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral letter in 40 minutes, about 180–200 words in the body.
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Case notes
NURSING — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 11/09/2026 Patient: Mr Nikolaos Papadakis, DOB 09/09/1950 (76 yrs) Oncology Ward 9, Southport Hospital, Southport Admission date: 02/09/2026 Discharge date: 11/09/2026 Social background: - Born in Crete, Greece. Retired fisherman - Lives with wife (Eleni, 74) in single-storey house. Wife is main carer; has hypertension; reports feeling "exhausted", sleeping poorly - Daughter (Sophia, 48) lives nearby, visits daily; 2 sons live interstate - Ex-smoker (40/day × 50 yrs, quit 2025) - Greek Orthodox; family have contacted parish priest - Enjoys football and backgammon Medical history: - Non-small cell lung cancer (adenocarcinoma) R lung, dx 03/2026; metastases to bone (spine, R hip) and liver - Palliative chemotherapy completed 07/2026; no further active treatment (pt decision 25/08/2026) - COPD - Hypertension - Gout - Appendicectomy 1970 - Allergy: tramadol (confusion) Nursing management and progress: 02/09 Admitted via ED: increasing SOB × 1 week; R hip/lower back pain 8/10. CXR: large R pleural effusion - Pleural tap: 1.4 L drained, SOB improved 04/09 Effusion re-accumulating → indwelling pleural catheter (IPC) inserted R side 05/09 BP 96/58 → amlodipine and ramipril ceased - Pain: morphine SR 30 mg BD + morphine oral liquid 10 mg 2-hrly PRN (using 3–4 doses/day) 06/09 Nausea → metoclopramide 10 mg TDS, effective - Constipation (BNO 4 days) → Movicol 2 sachets daily; BO 07/09 07/09 Palliative radiotherapy R hip (single fraction) 08/09 Pain 3/10 at rest, 5/10 on movement. Breakthrough doses reduced to 1–2/day - Appetite poor. Wt 58 kg (03/2026: 71 kg). Dexamethasone 4 mg mane commenced for appetite 09/09 IPC drained 800 mL (drainage Mon and Thu). SOB on minimal exertion; uses fan. SpO2 93% on air, O2 not required - Walks short distances with frame; needs help showering - Family meeting: pt wishes to die at home. Not for resuscitation (form completed). Daughter is substitute decision-maker 10/09 BGL 12.8 mmol/L on dexamethasone (not diabetic) → daily BGL monitoring - Pt asks if well enough for grandson's wedding (November); tearful - Hospital bed, commode and shower chair delivered to home 11/09 Pressure areas intact; Waterlow 20 (high risk) Medications on discharge: - Morphine SR 30 mg BD - Morphine oral liquid 10 mg 2-hrly PRN (breakthrough pain or breathlessness) - Movicol 2 sachets daily; docusate/senna 2 tabs nocte - Metoclopramide 10 mg TDS PRN - Dexamethasone 4 mg mane (review in 1 week) - Allopurinol 100 mg daily; tiotropium inhaler daily Discharge plan: - Referral to community palliative care: symptom review (pain, breathlessness, nausea, bowels); IPC drainage Mon/Thu (next 14/09); BGL monitoring while on dexamethasone; pressure care - GP to prescribe anticipatory (end-of-life) medications - Carer support and respite options for wife - Oncology telephone review in 4 weeks Writing Task: Using the information in the case notes, write a letter to Ms Chloe Beaumont, Community Palliative Care Nurse, Southport Palliative Care Service, 150 Esplanade Road, Southport, referring Mr Papadakis for ongoing symptom management at home. In your answer: - Expand the relevant notes into complete sentences - Do not use note form - Use letter format The body of the letter should be approximately 180–200 words.
How to approach this referral letter
- The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
- Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
- End with what you are asking the reader to do, and any action you have already taken.
Members also get the model answer, the note-selection table and task-specific tips for this task.