End-of-life discussions are likely one of the most challenging conversations physicians need to have. These conversations will become more common in our clinics as we start treating an increasingly aging patient population. For the next 18 years, 10,000 more Americans will become seniors each day because of the aging Baby Boomers. It is expected that by 2030, 1 in 5 US residents will be age 65 years or older. This means more patients with head and neck cancer, as well as terminal illnesses such as Alzheimer’s Disease. It is estimated that one in three seniors dies with Alzheimer’s or another dementia. By 2050 it is projected that 14 million Americans will live with Alzheimer’s and cost as high as 1.1 trillion dollars to care for. Therefore, a clear understanding of when and how to intervene in these problems is needed. This course aims to equip the Otolaryngologist with the necessary tools to use during these difficult discussions with their patients and caregivers. A very concise algorithm on how to have a fruitful conversation will be provided and will be strengthened with role-play to demonstrate clearly. Emphasis will also be given to hospice and palliative care discussion with terminal head and neck cancer patients, explaining timing, how to have them and why we should not delay these tough encounters.