To the Editor.
—A $28 million,1 5-hospital clinical trial failed "[t]o improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying."2 The study's investigators concluded: "Enhancing opportunities for more patient-physician communication, although advocated as the major method for improving patient outcomes, may be inadequate to change established practices."But how did the investigators try to enhance patient-physician communication? "[A] skilled nurse augmented the care team to elicit patient preferences, provide prognoses, enhance understanding, enable palliative care, and facilitate advance planning." These nurses were given the responsibility for initiating and continuing conversations with patients or families about, for example, CPR and reporting information about patient preferences to attending physicians. However, "there was no requirement for them [attending physicians] to share or discuss the information with the patient or family."It seems hardly surprising that the study's intervention did not improve patient-physician