Background: It is rare for patients who are early in their clinical course of metastatic cancer to receive information about the benefits of hospice programs or about advanced directives. The anti-cancer efforts of the medical oncology teams caring for newly diagnosed metastatic cancer patients do not often include improving the patients’ quality of life (QOL)-related needs. There is still a paucity of prospective randomized studies evaluating these interventions. We sought to examine QOL outcomes in advanced cancer patients who received early discussion-based palliative care interventions, and compare these outcomes with a control population. Methods: Patients were randomized to standard care or an ARNP-directed intervention that included discussions of the benefits of hospice, discussions on advanced directives (Five Wishes document) along with an assessment of quality of life. The primary endpoint was change from baseline in overall QOL (via the FACT-G measure), utilizing a single t-test with 80% power to detect a moderate effect size. Results: From November 3, 2008 through July 28, 2009, 26 patients were accrued at the Mayo Clinic in Jacksonville, Florida. The study closed early as a result of recently published data demonstrating the benefits of early palliative care interventions in the management of metastatic cancer patients. A statistically significant improvement from baseline in the FACT-G emotional domain was noted in the intervention group that was not seen in the control group (p=0.0106). Patients found it useful to have the living will and Five Wishes documents offered as part of the ARNP intervention. Conclusions: An early ARNP-directed intervention that explains the benefits of hospice and addresses advanced directives is well-received by metastatic cancer patients and their relatives, and leads to improvement in the patient’s emotional quality of life as assessed by the FACT-G tools. This represents a cost-effective approach that is integrated with the oncology team care and brings effective palliative care interventions early in the management of patients with metastatic cancers. Further studies are ongoing with a larger study cohort.