Conversations between clinicians and patients about goals of care become increasingly important when patients experience serious illness. The complexity of serious illness conversations multiplies dramatically when the patient is experiencing substance use disorders, mental health issues, homelessness or other challenges related to socio-economic factors (referred to as structural vulnerabilities). Currently, little is known about the preferences of structurally vulnerable patients while engaging in serious illness conversations. This is a major practice gap and an important area of palliative care research. Through one-on-one interviews, we will hear directly from patients about their experiences having these conversations. We will identify common themes and preferences for engaging in serious illness conversations. Ultimately, we hope to develop a best practice guide for clinicians and improve health care for patients experiencing structural vulnerabilities.