Ns (n = 4) There was considerable diversity of opinion. Some believed that discussions should really commence early, ahead of the onset of serious problems.28,20 Other people describe the lack of a clear threshold event, including a diagnosis, to prompt discussions leaving them to rely on physical or social cues.25 Although acknowledging their responsibility to initiate discussions, several feared that early discussions may possibly harm the hope that older individuals bring towards the patient hysician partnership.29 What would be the barriers to and facilitators of end-of-life care discussions A number of themes emerged in the literature:discussions, to accept that their Triptorelin relative is close to the finish of their life or wish to shield their loved a single from upsetting conversations.14,16,20,26,27,34,35 Breakdown in household relationships and lack of close loved ones were further obstacles identified.17,31,Professional and time limitations (n = 9). Concerns over healthcare professionals’ proficiency and willingness for end-oflife discussions20,27,29,35 PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21330032 and perceived lack of continuity of care and support23,31 are identified as barriers. Some physicians describe getting uncomfortable with the `paradox of promoting wellness and discussing its inevitable failure’.29 Health professionals also reported the pressure to see a large number of individuals and difficulty of scheduling timely follow-up visits conflicts with the time required for these conversations and so drastically reduced their ability to hold them.14,22,23,25,27 Patient reluctance to talk about (n = 8), feeling `others’ would decide (n = 4). Older frail folks were found to in some cases be unwilling to go over their end-of-life care17,20, 21,24,25,27,31,33 not wanting to talk about such `upsetting’21 and `negative’17 troubles, not feeling `ready to perform it’,21 or wanting to put off discussions to a time `if I ever possess a terminal illness’.33 They at times saw end-of-life care discussions because the responsibility of other people, generally family members.26,33 Some reported feeling content to leave such matters `in God’s hands’,18 or that `my physician will determine for me’.18 Difficulty arranging for uncertain future (n = 5). Dementialack of capacity (n = four). The challenges of unforeseen health-related scenarios plus the difficulty of creating well-informed decisions just before illness happens have been felt to inhibit end-of-life care preparing.16,20,21,26,33 While cognitive impairment plus a lack of selection producing capacity had been felt to become important barriers to arranging.20,27,31,35 The onset of dementia was identified as a prompt for early organizing.31 Administrative barriers (n = 4). A lack of details, inadequate time to take into account decisions and the legalistic paperwork involved in completing advance care plans have been all felt to be off-putting.16,17,29,dIScuSSIon Summary Important important themes emerge from this assessment. A minority of frail and older folks had end-of-life care conversationsFamilies (n = 10). By far the most often identified barrier to discussions will be the households of 
older frail men and women. It was felt they had been from time to time unwilling to haveBritish Journal of Common Practice, October 2013 eFunding Tim Sharp is funded by the UK National Institute of Well being and Analysis (NIHR) as an Academic Clinical Fellow in Key Care. Emily Moran and Stephen Barclay are funded by the NIHR CLAHRC (Collaborations for Leadership in Applied Wellness Analysis and Care) for Cambridgeshire and Peterborough, Stephen Barclay is also funded by Macmillan Cancer Support. The funders’ assistance is gratefully.