Physicians and other healthcare providers often struggle when communicating with seriously ill patients, particularly when broaching difficult topics such as the delivery of bad news and discussing goals of care. Multiple factors make these conversations difficult including patient expectations, uncertainty, patient and family emotions, and the lack of a cognitive framework for the conversation. This talk will offer an appreciation of the communication evidence related to what patients want from these conversations, the impact of communication on outcomes, what actually happens in practice, and what can be done to improve serious illness communication. The speaker will share research on using technological solutions to communication skills training, and will conclude with a talking map for discussing goals of care.