This study evaluated the effects of end-of-life discussions on communication goals and end-of-life care outcomes among 261 white and 71 black patients with advanced cancer. Among whites, end-of-life discussions were associated with attainment of communication goals, such as recognition that the illness was terminal, the development of preferences for symptom-directed care, and the institution of do-not-resuscitate (DNR) orders. These communication goals were in turn associated with less life-prolonging care at the end of life. Among blacks, however, communication did not result in less life-prolonging end-of-life care. End-of-life discussions between black patients and their physicians resulted in preferences for symptom-directed care and placement of DNR orders. However, these communication goals were not consistently associated with the end-of-life care actually received. For example, black patients with DNR orders were no less likely than black patients without DNR orders to receive life-prolonging care.