The message of SUPPORT: Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment. Change is long overdue.

The major findings of the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT), a multimillion dollar, multisite investigation of the process of dying in American hospitals, were extremely disappointing to the medical community. The major conclusion of this intervention study was that increased efforts to improve communication about patients' preferences for end-of-life care to physicians did not have a significant impact on the care that is provided in hospitals. In a commissioned series of papers to examine the conclusions of the study, numerous factors were identified as the possible reasons for the SUPPORT findings. Among the factors was the role of nurses in communicating patients' preferences to physicians. Nurses, however, were not participants in the design and conduct of this study nor were they among those who were respondents to the conclusions of SUPPORT. In this manuscript, an analysis of the report of the SUPPORT study itself and the commentaries commissioned by its funding agency are reported. Numerous issues about the scientific rigor of SUPPORT, the perceived roles of nurses in end-of-life decision making, and the need for interdisciplinary collaboration in health care and health care research are presented in an effort to ensure that nurses' contributions to the quality of patient care are recognized, acknowledged, and valued in the future.