Table 1 Examples of some of the communication practices featured in the RealTalk training resources

• Ways to encourage patients to talk (more), including use of body posture, gaze, and silence in ways that convey that the practitioner is ceding the ‘conversational floor’ to the patient.

• Empathic behaviours, including tone of voice, gestures and facial expressions, explicitly naming emotions, and practices that convey that one has insight and understanding whilst avoiding implying complete understanding of the patient’s own unique experience.

• Active listening – that is, encouraging the patient to say more and conveying that one is carefully attending, practices include use of body movement, gaze, and continuers (e.g. Mm, and Uhuh) in ways that show that the ‘conversational floor’ is the patient’s.

• Summarising both in the midst of, and towards the end of, consultations; how summaries can foreground particular matters, and can also be used to encourage talk about as yet undiscussed matters.

• Facilitating deepening disclosure in a careful and sensitive manner, including through follow-up questions and other cautious step-by-step moves towards more explicitly mentioning end-of-life concerns.

• Providing patients with opportunities to raise questions and concerns, in ways that encourage them to do so, and that steer them towards raising particularly sensitive matters about the future and end-of-life.

• Seeking patients’ perspectives and understandings before providing prognostic or other potentially distressing information, and providing that information in ways that take into account the patient’s perspective.