Lack of physician education and experience in conduction such a conversation ( Tulsky, Chesney, Lo, 1995). Resident physicians learn early in the course of their education that various attending and older resident have differing views on how and when end-of-life discussion should occur. Unfortunately, according to Tulsky, resident physicians receive very little education in how to conduct a discussion about end-of-life preference and consequently they “ often did not provide essential information “ (p.436).