Background: To examine urology trainees’ views about the quality and current practices of end-of-life care, and to explore strategies for improving integration and quality of care. Methods: We conducted semi-structured interviews with 20 urology trainees from four institutions in different regions of the United States. Stage of training ranged from intern to senior urologic oncology fellow; all were clinically active at busy academic institutions caring for many patients with advanced malignancies. Open-ended questions allowed participants to express themselves independently, and follow-up discussions explored their perception of current end-of-life practices, as well as avenues for future integration and improvement. We analyzed transcripts using a multi-stage, cutting-and-sorting technique in an inductive approach based on grounded theory analysis. Results: Clinicians unanimously agreed that their patients do not currently receive ideal care and were unanimously interested in joining a team geared towards improving care at the end-of-life. They expressed a preference for a multidisciplinary team, although the precise role each wanted to play within the team varied. Better identification of depression, pain, and patient-centered goals to allow value-congruent care were high in priorities for improvement. Trainees sited the lack of an educational curriculum on end-of-life care as a barrier to improving care, and expressed a desire for formal education on this topic. Conclusions: Urology trainees do not think that current care at the end-of-life is ideal for patients, and are interested in participating as part of a multidisciplinary team to better care for these individuals. There was a unanimous consensus that end-of-life care should be formally taught to all intern and resident physicians, and care at the end-of-life must be integrated to pursue value-congruent care for each patient. In response to the information gathered, we built a web-based, interactive, self-directed learning module emphasizing high-quality end-of-life care, issues to address with patients during clinic visits, and integration of end-of-life care. We have also integrated palliative care into the team caring for our patients with advanced disease.