Communication of prognosis may be an essential ingredient in the acceptance of life-limiting conditions, completion of advance directives, do-not-resuscitate orders, and the delineation of goals of care. However, nephrologists and dialysis staff have lacked training to meaningfully participate in these complex but much needed conversations. In recent years, guidelines have become available to assist medical personnel in communicating 'bad news' and introducing hospice and other EOL resources to patients and families in an honest and compassionate manner. Patients who talk with their physicians about approaching death are more satisfied with care than those who do not, and they also frequently request deaths take place at home. These results are consistent with other studies, suggesting that EOL communication between patients and physicians is associated with better outcomes, less expensive medical care, and decreased anxiety and depression on the part of the bereaved survivors.