Article Body:
Dealing with the end of life and the decisions that accompany it bring critical challenges for everyone involved-patients, families, friends and physicians. In fact, "managing" the progression toward death, particularly when a dire diagnosis has been made, can be a highly complex process. Each person involved is often challenged in a different way.

Communication is the first objective, and it should start with the physicians. In their role, physicians are often tasked to bridge the chasm between lifesaving and life-enhancing care; thus, they often struggle to balance hopefulness with truthfulness. Determining "how much information," "within what space of time" and "with what degree of directness for this particular patient" requires a skillful commitment that matures with age and experience.

A physician's guidance must be highly personalized and must consider prognosis, the risks and benefits of various interventions, the patient's symptom burden, the timeline ahead, the age and stage of life of the patient, and the quality of the patient's support system.

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