This article discusses the importance of multidisciplinary team in nursing palliative care for patients with complex conditions like Chronic Kidney Disease, Type 2 Diabetes, IHD, PVD, HT and a STEMI. It also talks about the goals of care and the barriers to communication that medical practitioners face. The article suggests that advanced care planning might be the best solution for patients like Betty, who have complex conditions and inadequate attention from family members.