Talking to seriously ill patients about their prognosis, the trajectory of their illness, and their treatment options can be a difficult conversation for clinicians to initiate. Patients are also uncomfortable proactively sharing their feelings on the topic with their physician or their families.  Because of the silence, there is typically a big gap between what a patient wants and what actually happens.

According to a Massachusetts Commission on End of Life Care/Massachusetts AARP survey done in 2005,