Background Patients end of life decisions (EOLD) are needed to be known in time to respect patient’s choices and to realise consistent end-of-life care. However, it is known that EOL topics are addressed often late, leading to delayed EOLD discussions followed by inconsistent EOL care.

Aim To evaluate patient’s preferences of how and when EOLD communications should occur.

Methods 89 patients with palliative stage advanced cancer were asked about their preferences concerning EOL conversations using a semi-structured interview. The interview focused on the importance patients gave to different end of life topics, the desired time point of the conversation and the mode of discussion initiation.

Results The results showed significant differences in the importance of EOL topics, F (4.3, 354.0) = 22.96, p < 0.001, with medical care and organisational aspects being the most important. Patients prefer to talk rather late (end of therapy/end of self-sufficiency: 48.7%; when the disease getting worse: 44.9%; only 6.4% at the disclosure or the beginning of therapy). Patients preferences to be spoken to differ by the given topic, with medical and nursing care (M = 2.30, SD = 1.39) should be addressed preponderantly to the patient.

Conclusion To respect patients preferences and overcome the dilemma of delayed EOL conversations a splitting of EOL conversations into two parts could be suggested: Focused “early” conversations about the course of the disease, handing all information concerning the necessity of EOL(D) conversations and the potential of cognitive impairment and serious crises, and depended on patients decision, an optionally later discussions focus on EOLD and more personal EOL aspects.