The long-term objective of this proposal is to improve the quality of end-of-life care provided by physicians. Specific aims are: 1) to establish the measurement characteristics of the questionnaire developed and pilot-tested by the team to assess physician performance at specific end-of-life care skills; 2) to assess the quality of end-of-life care provided by physicians who commonly care for dying patients, including oncologists, pulmonologists, cardiologists and nursing home physicians; 3) to explore mechanisms for implementing interventions for improving physician care for patients at end-of-life. This is a prospective cohort study of 120 physicians in the Northwest and Southeast United States. Physicians will each identify 15 patients (total=1,800) with life-limiting illness. We will enroll patients and a family member for each patient, as well as 15 nurses per physician (total=1,800) who are familiar with the physician?s skills. All participants will complete questionnaires assessing the physician?s skill at end-of-life care. The questionnaire data will be evaluated for measurement structure, reliability, and validity; respondent differences in questionnaire data will also be examined. We will provide feedback to physicians based on the questionnaire data. The study will identify specific strengths and weaknesses in end-of-life care provided by individual physicians and by physicians within the specialties under study. It will also provide exploratory data on present and potential nursing roles in improving end-of-life care. The validated questionnaire will be useful in educational, clinical, and research settings to assess and improve the quality of end-of-life care by physicians. The results will allow investigators and others to develop targeted educational and systemic interventions to improve the quality of this care.