Renal supportive care holds the promise of becoming an increasingly important and desirable aspect of patient-centered care in ESRD. The principal elements of SDM-RSC include: identification of high-mortality patients, initiating discussions with them and families, sharing decision-making and advance care planning to establish agreed level of care, and when appropriate changing the emphasis from curative to palliative treatments, such as withdrawal of dialysis and referral for hospice services. This study intends to challenge the current paradigm of EOL care of ESRD patients and establish whether delivery of prognostic information, encouragement of advance directives, and sensitive discussion of terminal treatment options, e.g. hospice services, by nephrologists and dialysis social workers, can together meaningfully alter the last remaining portion of patient lives and the care they receive. The trial will confront the issue of overuse—when an appropriate service, e.g. HD, continues to be provided under circumstances in which the potential for harm may exceed the possible benefit. Furthermore, the proposed trial may significantly improve the QOL of patients and provide the opportunity for higher quality care.