Having Realistic Conversations

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Realistic medicine in Scotland aims to make sure people using health and care services can discuss their treatment fully with professionals. Everyone should feel able to ask about possible tests, treatment or care plans and be encouraged to talk about any preferences and concerns they may have. Decisions about a person’s care should be agreed between the individual and their care team while taking account of what is available for them.

Talking with a person about ‘what matters to you’ and realistic options are key aspects of shared decision making discussions. Supporting professionals to discuss anticipatory care planning with individuals and those close to them is similarly a priority.

We can use proven conversation models and language to help us with these discussions.

These resources outline recommended approaches to having realistic conversations and offer toolkits for experienced facilitators delivering communication education webinars or workshops on:

  • shared decision making about treatment and care (SDM)
  • anticipatory care planning (ACP)
Shared Decision Making (SDM)


In health and care conversations, there are two experts - the professional who has clinical knowledge and skills and the person receiving care who is expert in their life and priorities.  

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.

NES has developed an interactive and reflective module on shared decision making which offers practical hints and tips on communication and how to talk about risks and statistics in ways that are meaningful to people.

Click on the image below for the Shared decision making module on Turas.


Having a structure for shared decision making conversations can be helpful. In Scotland, we recommend the DECIDE model.  DECIDE stands for Define, Explain, Consider, Invite, Decide, Evaluate, and you can use it when having a conversation with a person and their family to involve them fully in decision making about treatment and care.

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 shared decision making masterclass toolkit.

Anticipatory Care Planning (ACP)

ACP is about providing people with coordinated care while focusing on their goals and preferences and offering opportunities to consider realistic treatment and care options. Healthcare Improvement Scotland (HIS) has developed an ACP Toolkit for professionals that includes guidance on Meaningful ACP Conversations based on the REDMAP framework and the Scottish ACP conversation prompt cards. NHS Inform has ACP public information to help people prepare for conversations about thinking and planning ahead, as well as a short ACP video.

Having a structure for anticipatory care planning conversations can be helpful. In Scotland, we recommend the REDMAP framework.   REDMAP stands for Ready, Expect, Diagnosis, Matters, Actions, Plan, and you can use it when having a conversation with a person and their family about anticipatory care planning (ACP). It focuses the conversation on realistic options after exploring what matters to the person.

Click on the REDMAP framework below to find out more


If you are a communication trainer/facilitator, click here to find out more about the anticipatory care planning masterclass toolkits:
- Treatment Escalation Planning (TEP)
- ReSPECT Process
- Anticipatory care planning in the community


Content updated September 2022