However, most importantly, the SUPPORT study (Support Principle Investigators, 1995) suggested that since physicians did not understand their patients’ pref-erences about end-of-life care, they often continued ag-gressive, painful life-sustaining treatment beyond the time patients and their families believed was appropri¬ate. Because of that, families indicated that patients spent a considerable amount of time during their last days and hours in pain. One of the reasons offered for such aggressive care at the end of life in the SUPPORT