We explored how they felt about the care and support they were receiving from family, friends and HCPs and in their view, how well-informed they felt they had been by HCPs. We covered similar topics with relatives (sometimes in separate interviews and sometime in a joint interview with the patient – we discuss issues relating to this in a later

section). Most relevant to this paper we explored experiences of discussions between patients, family, friends and with HCPs, including discussions about future care, preferences Inhibitors,research,lifescience,medical for where patients would like to be cared for and any documentation of those discussions. Similar themes were explored in the follow up interviews with an emphasis on exploring what may have changed or stayed the same and why, in terms of patient preferences. Towards the Inhibitors,research,lifescience,medical end of the study we invited HCPs involved in the study to take part in a follow up interview to reflect and comment on the individual clinical cases that they had referred to us (patient consent included agreement for us to discuss their case with a nominated healthcare professional). These follow up interviews provided an additional perspective on if and how discussions about PPC were initiated. All interviews were digitally recorded then fully transcribed. Detailed

analysis of the Inhibitors,research,lifescience,medical interview material was undertaken using a constant comparative technique [24]. The research team (all authors) initially read through a selection of interviews separately to identify

identified themes emerging and then compared notes. This thematic analysis continued through regular research team meetings, readings and discussion of further interview transcripts and a coding framework was developed that KA and NM applied Inhibitors,research,lifescience,medical to a selection of Inhibitors,research,lifescience,medical transcripts. Codes applied were subsequently rationalised into one 56 item coding frame that was applied to all transcripts, assisted by NVivo software. Ethical approval was obtained from the Local Research Ethics Committee (ref no. 06/Q2404/123) and relevant NHS Trust approvals were also secured. Results Issues relating to the initiation of discussions around PPC This section reports primarily on findings from patient and carer interviews, but with some commentary from the follow up interviews carried out with HCPs, which adds an additional perspective to the accounts provided by patients and PCI-32765 solubility dmso family carers. Of the 18 patients interviewed, 13 were cancer or heart failure through patients. Of these 13, 9 had a degree of ‘open awareness’ [25]. They reported that they had engaged in some level of conversation with both family carers and/or HCPs about EOLC, although the depth, process and areas reported to have been addressed in these conversations varied. We employ the term ‘open awareness’ here to refer to patients’ acknowledgement of ‘certain death but at an unknown time’ [26]. The degree of ‘open awareness’ among the remaining four cancer and heart failure patients was harder to establish.