Background: Acute hospitals provide a high proportion of end-of-life care but some families experience poor communication with clinical staff. Aim: To evaluate the use of the Family’s Voice diary communication tool across nine healthcare settings. Methods: A mixed method practice development approach was used incorporating: an audit of the usage of Family’s Voice; collation and analysis of written comments; and collation of written feedback from the principal investigators at data collection sites. Findings: There were 112 completed diaries. Families rated pain and vomiting as well controlled, but agitation and breathlessness were difficult to control. Families were positive about care provided to the patients and themselves. Ten themes were identified from analysis of the families’ written comments that echoed national concerns. Conclusion: Evidence for the utility of the diary is building. Future work could focus on strategies for embedding the diary into routine care for all end-of-life patients.