Background: General practitioners (GPs) play an important role in initiating timely conversations about end-of-life with their patients. With population ageing, this needs to become a core skill for all GPs. However, end-of-life discussions often are not initiated until close to death, with previous research showing that GPs may shift their focus to comfort care without explicitly discussing this with patients. This may deny patients an opportunity to receive information about their health and make plans. Aim/Objectives: To explore GPs’ thought processes when deciding whether to initiate end-oflife conversations, and describe their approach to initiating these discussions. Methods: Fifteen GPs or GP registrars were interviewed. Transcripts were analysed using thematic synthesis. Findings: GPs believed initiating end-of-life discussions was their responsibility, though identified several factors that modulated this responsibility. Some described caution initiating end-of-life discussions related to patient, family, cultural and personal factors. GPs described an approach to initiating end-of-life conversationsthat included preparation, finding an entry point, tailoring communication and involving the patient’s family. Implications: The identification of specific reasons that GPs may be cautious to initiate end-of-life conversations provides a basis to develop tailored strategies to address these, and so facilitate timely initiation of end-of-life discussions with patients. The approach that GPs described also provides a practical framework for initiating end-of-life discussions that can be tailored according to the individual GP-patient relationship context.