OBJECTIVES: To explore how family members of ICU patients at high risk of dying respond to nursing communication strategies. BACKGROUND: Family members of ICU patients may face difficult decisions. Nurses are in a position to provide support. Evidence of specific strategies that nurses use to support decision-making and how family members respond to these strategies is lacking. METHODS: This is a prospective, qualitative descriptive study involving the family members of ICU patients identified as being at high risk of dying. RESULTS: Family members described five nursing approaches: Demonstrating concern, building rapport, demonstrating professionalism, providing factual information, and supporting decision-making. This study provides evidence that when using these approaches, nurses helped family members to cope; to have hope, confidence, and trust; to prepare for and accept impending death; and to make decisions. CONCLUSION: Knowledge lays a foundation for interventions targeting the areas important to family members and most likely to improve their ability to make decisions and their well-being.