To the Editor.
—The SUPPORT project1 found that an intervention designed to enhance health care decision making near the end of life failed to achieve improvements in end-of-life care. We are concerned that these results may lead many clinicians and the public to draw overly broad or negative conclusions about the possibility of improving terminal and palliative care in the United States. In various capacities, each of us has been involved in Decisions Near the End of Life, a national initiative to improve health care decision making for critically ill and terminally ill patients. To date, 160 hospitals and nursing homes in 31 states and approximately 35 000 health care professionals are participating in this initiative. These facilities constitute a virtual laboratory for looking more closely at whether and how end-of-life care can be improved.We have seen that change is possible, but only if program planners adopt a