Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings.

From her cubicle at Vital Decisions in Cherry Hill, N.J., Kate Schleicher counsels people with terminal illnesses. (Photo by Emma Lee/WHYY)

"My name is Kate. I'm a health care counselor," the gentle voice says from her cubicle in Cherry Hill, N.J..

This is no telemarketing call …  it's about the end of your life.  

Kate Schleicher, 27,  is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she knows your phone number, your insurance provider and that you are pretty sick.

Schleicher is one of 50 social workers at a company called Vital Decisions. After sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as 'nondirected' end-of-life counseling. The company gave a reporter permission to listen to and record the social workers' side of some of these calls.

 "When you say that getting better is the most important thing on your mind, what does that look like for you?" Schleicher asks a man in Rhode Island.

"Breathing. Ok," she repeats back, as he describes what a struggle it has become for him. "I also hear concern from you that I don't think that's necessarily going to happen," Schleicher continues. "Has someone told you that, or is that your own feeling?"

The call lasts about 15 minutes. Schleicher asks if it's ok to follow up, in a month or so. The hope of this program, she says, is to build a relationship over the phone, so he might be comfortable discussing his situation and his goals. Then he'll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It's paid for by insurers and federal privacy rules permit this for business purposes.  

An Often-Avoided Topic 

CEO Mitchell Daitz believes critical conversations about end-of-life care just aren't happening enough and the company's goal is to foster them.

"The accepted norm in terms of the role of the individual who's going through this advanced illness experience is to be passive and be along for the ride, not to take charge, not to take control and ask for help," says Daitz, adding that navigating care and an individual's priorities can become increasingly difficult as a disease progresses. "So when you're faced with a set of choices, that none of which represent a really good choice, you become ambivalent."

*This story is part of a partnership that includes WHYY's Newsworks, NPR and Kaiser Health News.