Table 4 Recommendation 3: Create opportunities to discuss the future

The following strategies are particularly useful for occasions where patients or family members seem reluctant to engage in discussions about future illness progression or end of life.

Highlight connections between what a patient or family member has said and what you are saying now

To promote further talk about future illness progression and end of life, try bringing up something the patient or family member has mentioned before about the future, then use this to promote further discussion about this matter. You can help them link concerns they have already expressed with concerns about and plans for end of life.

Use hypothetical scenarios to explore possibilities when you think it is important to talk about the future in this conversation

Talking about the future hypothetically means patients and family members do not need to agree that this is necessarily how their future will transpire. Evidence suggests people can be more open to engaging in these types of hypothetical discussions. If you judge it important to pursue discussion about a patient's illness progression and end of life, hypothetical scenarios can be used to promote this.

Refer to illness progression and end of life generally, if you are unsure how a patient or family member will react

Mentioning something in relation to people generally, rather than the patient specifically (e.g., “when people are very ill…”), can be useful when you want to raise something that a patient or family member hasn’t already hinted at, or where you want to provide them with an opportunity to recognise its relevance to them and apply it to their own situation, but without forcing them to do so.