Having Realistic Conversations
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 future 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)
- future care planning
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.
Future Care Planning
Future care planning means having conversations with people about changes in their life, health and care and what matters to them now and in the future. It offers people opportunities to discuss realistic, value-based options for their treatment and care. 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 talk about it with family or friends and staff, including a short video. NHS inform: future care planning
Having a structure for future 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 the people important to them about future care planning. It focuses the conversations on realistic options after exploring what matters to the person.
Select the REDMAP framework below to find out more.
Download your copy of the future care planning conversations guide for staff.
Future care planning aligns with Realistic Medicine including ‘shared decision making’ and ‘build personalised care’.
If you are a communication trainer/facilitator, select the links below to find out more about the future care planning masterclass toolkits:
- Future care planning
- Treatment Escalation Planning (TEP) in hospital
Content updated September 2025
