Communication of prognosis is a key step in EOL planning, but occurs infrequently or extremely late in the dying process among patients with ESRD. Most ESRD patients want to learn about EOL issues, and according to Davison, the most valued components are being informed about prognosis, treatment options (including withdrawal from dialysis) and planning for death. In two studies, 95% and 97% of patients with ESRD preferred to be given life-expectancy information—even if their prognosis was poor—and patients specifically wanted their physician to disclose this information without prompting. Nevertheless, nephrologists and dialysis staff infrequently discuss EOL issues with patients and families, although they repeatedly face difficult determinations about treatment options, including whether to discontinue renal replacement therapies or to consider referral for hospice services. Despite national guidelines and an explicit recommendation by the Renal Physicians Association and American Society of Nephrology, patients and their family members or surrogate decision makers are often not provided with available information. This may help explain why only one-in-five dying dialysis patients currently receive hospice care—about half that of national figures for overall deaths in the United States and one-fourth that of people dying from cancer.