Providers and their dying patients are stuck in a dysfunctional interpersonal logic that has emerged within the hospital context. Their impasse delays the palliative care that can relieve physical and emotional suffering, dramatically impacting their quality of life. We propose a dialogic intervention: An ongoing conversation in which patients and their families bring life to their personal meanings for post diagnosis caregiving decisions and caregiving tasks. Based upon multiple theoretical models as well as therapeutic and organizational experience, we offer several suggestions for breaking the end of life communication impasse. We believe that giving patients and their families the opportunity to self organize around caregiving will end the end of life impasse. We suggest that family centered post diagnosis care planning conversations with patients and their loved ones will better prepare them to accept hospice earlier than they do today. We propose that patients and their significant others who engage in repeated family centered care planning scenarios will overcome the impasse that exists in the current decision making process.