This multi-centered qualitative study was conducted in two phases. From August 2000 to July 2002, we audio-taped physician–surrogate conferences in the ICU of four hospitals in Seattle, Washington, including a county hospital serving an inner city population, a university hospital, and two community hospitals. These data, which comprised the derivation cohort, were originally collected to study the general topic of how physicians and surrogates communicate in ICU. For the current study, we conducted a secondary analysis to determine the roles physicians play in decisions about whether to limit life support. In the second phase of the study (the validation cohort), conducted from January 2006 through August 2008, we audio-taped physician–surrogate conferences at two hospitals in San Francisco, California. One hospital is a tertiary care center; the other is a county hospital serving a largely indigent population. Screening procedures and enrollment criteria were identical during both phases of the study. Study procedures have been described previously, although no previous report has described the roles physicians played in life support decisions (36 (link)–39 (link)). Through daily contact with charge nurses we identified eligible ICU family conferences meeting all of the following criteria: 1) occurring on weekdays; 2) including family and physicians; and 3) all participants conversing in English without an interpreter. To specifically identify conferences in which there would be deliberation about end-of-life treatment decisions, we asked the patient’s attending physicians if they anticipated that there would be discussion of withholding or withdrawing treatment or discussing bad news. We excluded conferences in which the physician stated that these issues would not be discussed. Conferences concerning patients younger than 18 yrs were also excluded. The conferences represent a consecutive sample of eligible family conferences that occurred on weekdays. The attending physician and bedside nurse provided permission to approach each family. After discussions with study staff and execution of consent forms by all participants, the conference was audio-taped. Institutional Review Boards at each hospital approved all procedures.