Discussing end-of-life matters with people can be challenging. Explore these conversation starters from Kelley Newcomer, M.D., assistant professor in the department of internal medicine at UT Southwestern Medical Center.

Identify other decision makers

“Is there anyone you rely on to help you make important decisions?”

“Who in the family should be with us when we discuss the results?”

Assess understanding of prognosis

“What have your other doctors told you about your condition?” “Have they talked to you about what this latest problem might mean for you?”

“From what you know, do you think that over the next month your cancer will get better, worse, or stay the same?”

Define the patient’s goals for care

“What do you hope for most in the next few months?”

Reframe goals

 “I wish we could guarantee that we could keep you alive until your daughter’s graduation; but unfortunately, we can’t. Perhaps we can work together on a letter for her to read on that day, so she will know you are there in spirit in case you cannot be there.”

Identify needs for care

“It can be difficult to care for a family member at home, and no one can do it alone.

 Have you thought about what kinds of help you might need?”

“Would it help if we could find a way to deliver your medications to you?”

“Would it reassure you if we could send a nurse out to your home to check on you?”

Summarize and link goals with care needs

“So I think I understand that your main goal is to stay at home and spend time with your family. To do that, we will need to help you in several ways, for instance, by sending a nurse out to your home and giving you both some help around the house. Is that right?” 

Language to introduce hospice

“One of the best ways to give you the help that you will need to stay at home with your family is a program called hospice. Have you heard of hospice?”

“Hospice is able to provide more services and support at home than most other care programs.”

 “The hospice team has a lot of experience caring for seriously ill patients at home.”

Respond to emotions and provide closure

Acknowledge response

“You seem surprised to learn how sick you are.” “I can see it’s not easy for you to talk about hospice.”

Legitimize reaction

“Many people are understandably upset when they learn how ill their loved one is and that hospice is a possibility.”

Explain hospice goals

“Hospice doesn’t help people die sooner. Hospice helps people die naturally, in their own time.” “Hospice helps people live as well as they can for as long as they can.”


“Hospice’s goal is to improve your quality of life as much as possible for whatever time you have left.” “Hospice can help you and your family make the most of the time you have left.”

Reinforce commitment to care

“Let’s think this over for a day or two; you know I will continue to care for you whatever decision you make.”

When recommending hospice

“I think that hospice would be your best choice right now, but of course the final decision is yours.”

“Hospice could be very helpful to you in the ways that we’ve talked about, but I realize it’s a big decision. I’d like to arrange for a hospice nurse to visit you so you can decide for yourself whether hospice is right for you.”