BackgroundDesire to die (DD) is not uncommon in palliative patients. Medical advance and improved therapy options do not prevent these wishes, but on the contrary a lot of patients think about their future and ask about the meaning of life. Health practitioners are often confronted with these thoughts.AimsTo present the current national and international state of knowledge and experience in dealing with DD and to offer orientation and assurance in responding to it in an appropriate manner. MethodsDevelopment of evidence and consensus based recommendations with the participation of more than 60 professional societies. Medline, PsycInfo, and Cochrane Library databases were systematically searched for relevant publications on proactively addressing DD, and selected according to defined inclusion criteria. The included ones were assessed and built the base for developing recommendations. Evidence based and consensus based statements were consented in a formal process.ResultsThe expert panel agreed on 19 statements and recommendations dealing with DD issues like the differential diagnosis, potential background and meaning, how to deal with DD, possible options for action and the legal framework. Also the handling of DD within the treatment team, possible support from external experts and the involvement of relatives are covered within the guideline.Conclusion / DiscussiontThe guideline aims to support decision-making in practice and provides systematically developed recommendations on the basis of the best possible evidence and clinical experience of a large number of experts. The recommendations concerning DD aim at helping with (proactively) addressing potential DD as well as dealing with them. Therefore they should be considered a contribution to the advancement of multi-professional competence in palliative care. Funding: German Guideline Program in Oncology (GGPO).