The patient gave some indication of his preferences to the researcher about his wishes. However, the HCPs felt he steered them away from such conversations, such that it was perceived to be too difficult and possibly unethical to open up discussions about his preferences for EOLC. Patients and relatives rarely gave lengthy accounts of discussions about preferences for place of care and deathj. Only one set of interviews (joint initial and follow up interviews with a patient with cancer and his wife) provided a Inhibitors,research,lifescience,medical more extended illustration of ongoing conversations with HCPs on EOLC preferences. This patient had a PPC document in place, indicating

a preference to be cared for and to die

at home. At the follow up interview Inhibitors,research,lifescience,medical 6 months later the couple reported on discussions with the district nurses to address some of the practicalities as to how their preferences might be achieved, although the review and selleck chem inhibitor additional information was not recorded in their PPC document. The nominated HCPs involved in the care of this patient reported that in this case it had been the patient and his wife had Pacritinib initiated conversations about EOLC and preferences: HCP1: The first time I met them, I walked in and it was just as though it was a case of, it was like an open book HCP2: We’ve talked to them about where he wants to Inhibitors,research,lifescience,medical die and what the future possibly holds and how she is going to cope, what services are available, that’s been a conversation we’ve Inhibitors,research,lifescience,medical had right from the beginning. It was initiated by them right at the beginning and a couple of times they’ve initiated it to re-visit (S1 FU).

It is interesting to note that the only case of apparently detailed discussion was initiated by the patient. The HCPs identified two key factors which Inhibitors,research,lifescience,medical enabled them to have initial and on-going conversations with the patient and his wife. First, that the couple were very open to having such conversations and second, that over time they developed a depth of rapport with this couple. Health care professionals’ reports of discussions with Carfilzomib patients about preferences for end of life care The above section presents HCPs views on specific cases, drawing on data from the follow up interviews carried out. Here we report briefly on more general reflections from the discussion group interviews with HCPs on a range of factors that influence if, when and how they initiate discussions about preferences for EOLC, summarized in Table ​Table55. Table 5 Raising the topic of PPC with patients: factors identified by healthcare professionals Gauging patients’ level of awareness and/or denial (which may also be present at variable levels at different points in time) presents a key challenge for HCPs working with both heart failure and cancer patients.