A match between patient goals and the care received should be the gold standard for quality medical management. Meaningful end-of-life (EOL) conversations are associated with increased hospice referral, less aggressive and expensive medical treatment, and improved satisfaction on the part of families. However, a survey of ESRD patients reported less than 10% having a conversation about any EOL issues with their nephrologist in the previous year, and more than 90% endorsed that none of their physicians had ever discussed how much time they had to live. It is not known whether an intervention that targets deficiencies in communication and terminal care planning can improve EOL outcomes. This is an area that has been neglected in ESRD research, yet should have tremendous importance to patients, families, and policy-makers.