This study will test whether the SDM-RSC intervention compared to usual care improves EOL care, including: increased hospice use, enhanced EOL planning, and improved patient and caregiver satisfaction. The multi-modal SDM-RSC intervention communicates prognosis in a face-to-face encounter, uses an algorithm-based social work intervention, and provides hospice outreach. This study will be recruiting subjects from 16 dialysis units associated with 2 clinical centers—Baystate-Tufts (8), University of New Mexico (8). The study sample will be selected using a validated prognostic tool to enrich the pool of patients who have a high risk of mortality and are most likely to benefit from the SDM-RSC intervention. Subjects will be recruited over 6 months and enrolled subjects will be treated and followed for at least 18 months.