Table 5 Raising the topic of PPC with patients: factors identified by healthcare professionals

Factors that influence IF conversations are initiated:

1. Barrier of inexperience: the need for training and developing experience in advanced communication skills

2. Judgement call on patient’s level of awareness/denial

3. Unwillingness of relatives to have these conversations

4. Uncertainty of trajectory with long term conditions (heart failure)

Factors that influence WHEN conversations about PPC take place

1. Patients initiate or ask for information

2. Judgement on timing – don’t want to concern patients/relatives too early (nor leave it too late)

3. Once preparatory work is carried out (getting to know the patient; planning what to say)

4. Because of pressure to follow policy guidelines and find out patient preferences

Factors that influence HOW these conversations take place

1. Taking a ‘drip drip’ approach

2. Use of trigger questions

3. Different choice of language e.g. some HCPs will use the words death and dying; some would not