Clear communication between health care providers and their patients is seen as “best practice” in medicine, especially for patients facing serious, life limiting illness. The purpose of this study is to understand how hospice patients and their family members perceive the quality of their communication with care providers when discussing diagnosis, prognosis, and care planning. Data are drawn from in-depth interviews with a sample of hospice patients (n=20) and family members involved in care (n=37). Findings suggest that the majority of patients feel very positive about hospice care in general. However, patients also indicate that providers generally do not communicate in explicit or clear terms with them about prognosis, leading to confusion about life expectancy. Patients who report that clinicians communicated prognosis in a more direct way are more confidant in care received. We suggest that physician communication skills when giving terminal prognosis may have a significant effect on patient satisfaction and quality of life.