Inclusion Criteria:  Seriously ill adults with median life expectancy of two years or less (e.g. metastatic cancer or inoperable lung cancer, chronic obstructive pulmonary disease (COPD) with forced expiratory volume in 1 second (FEV1) <35% predicted or oxygen dependence, restrictive lung disease with total lung capacity (TLC) <50% predicted, New York Heart Association (NYHA) class III or IV heart failure, or Child's class C cirrhosis or Model for End Stage Liver Disease(MELD) >17) Hospitalized at either Harborview Medical Center or University of Washington Medical Center-Montlake At least 18 years of age English-speaking No cognitive impairment precluding completion of surveys or participation in the PRISM sessions  Exclusion Criteria:  Younger than 18 years of age Non-English speaking Ccgnitive impairment that would preclude completion of surveys and participation in the PRISM sessions.