We have identified a major barrier in the management of dialysis patients: the dearth of communication between staff and patients about prognosis and EOL considerations. Without these conversations, this population will continue to receive overly demanding and expensive treatments, infrequent referrals for hospice services, and a diminished quality of life and death. The extensive preliminary work preceding this study, which began with focus groups involving patients and families, has allowed us to develop and validate an accurate prognostic instrument for the identification of HD patients with poor short-term survival expectancy. The multimodal SDM-RSC intervention takes advantage of the existing interdisciplinary team approach that is the bedrock of HD practice, and it empowers the social worker to engage in EOL communication with the patients and their loved ones. The SDM-RSC intervention is designed to be practical, adaptable to existing staff, and easily replicated in dialysis facilities throughout the country. Additional involvement of patient-partners from two distinct sections of the country will greatly improve the protocol.