This landmark study took place over a four year period of time and included 9,105 seriously ill hospitalized clients and their physicians. Its main objective was to improve end of life decision making and reduce the frequency of painful, mechanically supported, prolonged patterns of dying. Findings indicate that despite well planned, comprehensive interventions to improve study outcomes, clients in the intervention group fared no better than their counterparts in the control group. These findings have serious implications for those working in hospice and palliative care.