Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life care (ITEOL).

Method: Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population, and proportion of patients receiving ITEOL at baseline.

Inclusion Criteria:

• Hospitals and municipalities: Participation in the Swedish Register of Palliative Care.
• Patients: Reported from an included hospital or municipality during six months before to six months after intervention.

Exclusion Criteria:

• Hospitals and municipalities: Exclusion criteria were more than 40% patients receiving ITEOL at start of study, too large for an intervention due to practical reasons (university hospitals or municipalities with over 100 000 inhabitants), and hospitals not containing both internal medicine and surgery departments.
• Patients were excluded when death was unexpected, when a forensic post mortem examination was performed, or when the patients had lost their ability to express their will and take part in decisions concerning the content of medical care one week or more before death.