Background As part of the research project “End-of-life Communication in Nursing Homes. Patient Preferences and Participation”, we have carried out a qualitative study of the practice of and experiences with preparatory conversations in 8 nursing homes. These conversations took place between the nursing home physician, nurse and/or other staff members and resident and/or relative. The conversations were part of the nursing home’s routines to ensure mutual information and trust, as well as communication about end-of-life care and medical decision-making.

Aim To study how such conversations are carried out and what the content of the conversation is. To study how the staff and the residents and/or relatives experience these conversations. To identify good practice; this will be useful when developing a guide for preparatory conversation.

Methods Participant observations of preparatory conversations, followed by interviews with residents and relatives together on how they experienced talking about end-of-life and medical decisions. Interviews with staff about their experience of asking questions, and talking about end-of-life issues and medical decisions.

Results Residents and relatives were poorly prepared to discuss end-of-life issues, and it was challenging to understand or interpret the patients’ wishes or decisions. The conversations seemed influenced and driven by what health care professionals found to be important.

Discussion How to develop preparatory conversation in a way that strengthens the residents’ perspectives and interests?

Conclusion It is very important to understand preparatory conversations as a process over time. Staff needs to be sensitive and open to what is significant in the resident’s life.