Having Realistic Conversations
Realistic medicine in Scotland aims to put people using health and care services at the centre of decisions about their care. People close to the person may be involved too. Everyone should feel able and supported to ask about available tests, treatments or care. This includes inviting them to talk about ‘what matters to you’ and share any preferences or concerns they may have. This is how we enable careful and kind care.
Introduction
These education and training resources outline recommended approaches to having realistic conversations with people and offer toolkits for experienced facilitators delivering communication education for health and social care staff or workers on:
- Shared decision making about treatment and care
- Future care planning
Shared Decision Making
For people to reach the right decision for them, they need to be able to weigh up the potential benefits, harms and limitations of the available options. We need to find out what is important to each person, such as their values, beliefs and how this decision fits into the wider context of their life. Once we know the person’s priorities and preferences, we can look at the options together based on what the person hopes to achieve and what is important to them.
More on Shared Decision Making
Having a structure for Shared Decision Making conversations can be helpful. In Scotland, we recommend the DECIDE model. DECIDE can be used when having a conversation with a person and the people important to them, or for staff education and training.
Click on the DECIDE model below to find out more.
If you are a communication trainer/facilitator, click on the tool icon to find out more about the communication education toolkit for shared decision making.
Future Care Planning
Future care planning helps people manage changes in their life, health and care. We talk about what matters to them now and in the future. Future care planning is for people of all ages and usually includes the people important to that individual. It is particularly helpful when people are living with disabilities, long term conditions or life shortening conditions, and for older people whose health is changing.
Future care plans can include information about the person and what matters to them, alongside advice from the staff who know them, to guide decision making if the person needs urgent or emergency treatment or care.
NHS Inform has public information on future care planning to help people find out more. It includes a short video. There is also information on ways to talk with people, their family or friends.
NHS inform: future care planning
Having a structure for Future Care Planning conversations can be helpful. In Scotland, we recommend the REDMAP framework. REDMAP can be used when having a conversation with a person and the people important to them, or for staff education and training about future care planning.
Click on the REDMAP framework below to find out more.
If you are a communication trainer/facilitator, click the links below to find out more about the communication education toolkits for:
- Future care planning
- Treatment Escalation Planning (TEP) in hospital
Content updated June 2026