Background Collusion in healthcare is the act of withholding information from the individuals involved. Across a range of cultures, collusion is extremely common in end of life care: up to half of patients in India receiving cancer treatment are unaware of their diagnosis (Santosh, 2009). To our knowledge, no studies have used qualitative techniques to explore the beliefs and attitudes underlying this common and controversial practice.

Aim Our study sought to explore medical students’ attitudes to collusion, employing qualitative techniques to optimise depth and authenticity. Our ultimate aim is to promote awareness of the issues surrounding collusion in order to develop communication skills training appropriate for an increasingly culturally diverse environment.

Methods 15 student volunteers from final year and third year participated in three 30 min focus groups. Our students study a UK degree in a Malaysian context, providing unique insight into cross-cultural differences. Discussions were facilitated by the authors, using open facilitatory questions which explored students’ thoughts on collusion and observations in practice. The recorded transcript was processed using simple content analysis: following initial coding, codes were drawn into categories to provide a conceptual framework.

Results Our students expressed conflicting reactions to collusion. In favour of collusion, they cited cultural setting, family expectations, patients’ mindset and doctors’ attitudes. Conversely, they felt that a number of factors supported disclosure, including legal and ethical frameworks, personal beliefs and the practical benefits of knowledge for the patient. The resulting dilemma was felt strongly and intense reservations were expressed about navigating these tensions in practice.

Conclusion We feel that we have identified an important area for further study. Students experience conflicting demands regarding end of life communication. We advocate development of communication skills teaching to support students through these dilemmas in a culturally interconnected world.