understanding
dying
From uncertainty to understanding
at the end of life.
WHO WE ARE
Builders, clinicians, and forty years at the bedside.
Eric Verkerke
CEO
Strategy, innovation, & creative leadership for the common good. Co-founder of Emergence Creative. Behavior change, brand strategy, & building mission-driven organizations from idea to scale. Marlboro, UVA, Oxford alum. First-time CEO, second-time founder.
Tim Short, MD
Founder & Clinical Lead
Palliative Medicine at University of Virginia. Board-certified in family medicine, hospice, & palliative care. Former UVA Health faculty & hospice CMO. Developer of the UD curriculum.
Kelly Short
Head of Product & AI Strategy
Data platforms & data-science systems across a career in enterprise software in regulated industries. Recent focus on generative AI (MA, UC Berkeley). Applies technologies with human-centered design at the core.
BOARD
Dave Fleming, PhD · Board Chairman · Strategic Advisor, The Ingenuity Lab
Dave Short · Treasurer · Former Co-CEO & Chairman, American Funds / Capital Group
ADVISORY BOARD (Forming)
Clinical Advisory Board · Ethics Advisory · Clinical Safety Review
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Terri Maxwell, PhD, APRN
Clinical Operations & Strategy
Healthcare strategist and former Chief Clinical Officer with deep expertise in palliative care, hospice, oncology, and value-based care. Experienced in designing and scaling models of serious illness care .
Product design & engineering partner.
Designed & built the platform infrastructure, from user research through launch.
Engineering & compliance partner.
HIPAA, SOC 2, security, & responsible AI governance. Partners with multiple startup exits & product/market scale in remote patient monitoring, nurse recruiting, & point of care education.
Both sides of the bedside, facing the end together.
Understanding Dying replaces silence and uncertainty with shared understanding.
It deepens as we learn through partnership
and use.
FOUNDATIONS: RESEARCH AND EXPERTISE
1
Clinically Grounded Content
Developed by Dr. Tim Short and NP Ken White with over 40 years of bedside practice across palliative medicine, hospice, and nursing leadership. Validated through the Macy Scholars Harvard program.
Every part of the experience is built on trusted clinical foundations, designed to grow:
2
Responsible, Guardrailed AI
We researched how to keep our AI safe and clinically sound: designed to support clinicians, not replace them, with expert validation and guardrails grounded in vetted content.
3
Expanding With Evidence Based Content
Integration with the ELNEC and EPEC curriculums, links out to Fast Fact pages, with a resource library that deepens as partnerships and real-world use grow.
4
Continuously Validated with the Users
User research and feedback refine the product at every stage of development.
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WHAT IT HELPS WITH
✓ Prepares Clinicians for
Difficult Conversations
✓ Normalizes the Natural Dying
Process
✓ Provides Trusted
Micro-Education Modules
✓ Promotes Shared
Understanding
WHAT IT IS
What Understanding Dying Is - and is not
Understanding Dying is a compassionate, integrative digital platform that bridges the communication and emotional support gap between patients, families, and healthcare professionals at the end of life.
THE SHORT VERSION
A shared decision-making and communication-support platform for serious illness, dying, and end-of-life care.
WHAT IT IS NOT
✕ Clinical judgment
✕ Site policy
✕ A palliative or ethics consult
✓
✓
✓
✕
✕
✕
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✓
✓
Platform Features
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A shared decision making tool for patients, clinicians, and families. Wherever and whenever they need it.
THE PLATFORM
Tools for understanding dying.
Symptom Support
Practical symptom guidance that helps families understand, normalize and respond to common symptoms. Always defers to care team for dosing or treatment recommendations
Conversation Practice
Conversation coaching for complex clinical discussions: goals-of-care meetings, sharing hard news, code status. In-line coach and feedback built on ELNEC teaching points.
Patient Values
& Legacy
Shareable values card and legacy recordings give patients a voice and connect them with family and care team.
Clinically Validated Resources
Evidence-based, personalized versions of all resources for patients, families, and clinicians navigating the end of life.
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Made for Patients
Made for Clinicians
Made for Families
Personalized for Every Role
Onboarding
Meeting users at their level
Made for Patients
Made for Clinicians
Made for Families
Personalized for Every Role
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Resources
Made for Patients
Made for Clinicians
Made for Families
Personalized for Every Role
Trusted role-specific guidance in the moment
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Patient Values Card
Made for Patients
Made for Families
Personalized for Every Role
Giving Patients a Voice
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Conversation Practice
Made for Clinicians
Made for Families
Personalized for Every Role
Supporting Difficult Conversations
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Symptoms
Made for Patients
Made for Clinicians
Made for Families
Personalized for Every Role
Contextualization of Symptoms
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Legacy Building
Made for Patients
Made for Families
Personalized for Every Role
A Space to Reflect and Remember
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HOW TO USE IT & WHERE IT FITS
How Clinicians Use It In Practice
Conversation
Practice
Symptom
Support
Patient Values
& Legacy
Clinically Validated
Resources
CLINICIANS USE IT THEMSELVES
CLINICIANS REFER IT TO PATIENTS & FAMILIES
Prepare for difficult conversation to support more effective shared decision making
Code Status Conversations · Family Meeting · Prognosis
Check grounded, plain-language guidance before walking into the room
Potential Contributing Factors· Practical Guidance · SBAR
Review patient’s values prior to a goals-of-care conversation
Values Card
Quick clinical refreshers and self care support with links to relevant Fast Facts and other trusted resources
Ethical & Legal Aspects of Care · Self Care
Help family prepare for difficult conversations they may need to have
Code Status Conversations · Family Meeting
To answer a family’s symptom-related questions and provide practical tips for management
Controlling Pain· Confusion Near Death
Give patients space to reflect on what matters most and share with family and healthcare team
Values Card· Legacy Recordings
Send resources home to enhance patient and caregivers understanding of their care & options
Palliative Hospice & Comfort Care · Feeling Burned Out
Some features clinicians use themselves; others they offer to patients and families
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For Any Questions Please Contact: kelly@understandingdying.com
Conversation Practice
Made for Clinicians
Made for Families
Personalized for Every Role
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UNDER THE HOOD
Conversation Practice: Architecture & Build
A LangGraph workflow turns a validated scenario card into three distinct LLM roles - the coach nudges use ELNEC frameworks as guidance throughout the conversation
Scenario Card
Three LLM Roles
Persistent & Respond
18 Validated Cards
NURSE + Ask-Tell-Ask Frameworks
One action per request
Structured Conversation Cards
Persona, Counterpart, Ordered Stages of Conversation, Teaching Points, 4-dimension rubric
Guardrails baked in
Must_not_do + safe_alternatives + escalation triggers
Simulator
Plays one counterpart role at a time, Plan to expand to multi-role simulation as V2
Test Bas
Inline Coach
Nudges using NURSE / Ask-Tell-Ask behaviors, never the label
Evaluator
Scores the card’s rubric, quoting the transcript verbatim
LangGraph Router
Start ∙ send_message ∙ advance_stage ∙ ask_coach ∙ finish
Supabase & Langfuse
Session state + full transcripts in supabase, detailed tracing in langfuse
Structured Output
pydantic/JSON responses shaped to the API contract
Technical Stack: LangGraph (python) ∙ Pydantic-validated YAML Scenario Library ∙ Supabase Persistence ∙ Langfuse Tracing ∙ Gemini Models
EVALUATION OVERVIEW
How We Evaluate
A Production-first methodology, validated in three layers, Testing against prompt, context and model variants
LAYER 1 - CODE CHECKS Deterministic checks - schema validity, boundary tripwires - runs CI on every change
LAYER 2 - LLM JUDGE - What We measure by Component
SIMULATOR
COACH
EVALUATOR
LAYER 3 - CLINICAL EXPERT REVIEW
Per-Scenario Sign-Off
Clinical experts review ad sign off on each scenario - owning every nuanced and safety flagged case
Generate, Then Label
A session is generated, then labeled - verdicts logged back to Langfuse as scores, End state: a labeling tool for experts
Golden + Synthetic Data
Gold dataset from SME-generated sessions (skillful + realistic, imperfect runs), plus synthetic safety-flagged cases that stress test
STRATEGIC PARTNERSHIP
Partnering with You
WHAT WE ADMIRE ABOUT VITALTALK
Twenty years of research turned into practice clinicians actually use and a curriculum that stays faculty-owned even as it scales to over a thousand institutions
Best Case Worst Case ∙ Delivering Serious News ∙ Navigating Serious Conversations ∙ the REMAP framework ∙ Train-the-Trainer Model
Partnership Ideas:
Integrate Curriculum
Co-Brand the Feature
Refer Into Ecosystems
Vital Talk Frameworks, in our logic
Vital Talk Brand, our Engine
Complement and Refer Training
License content for Convo Practice
REMAP, headlines, empathy, goals-of-care teaching points
Add new Vital Talk Resources
Identify and add Vital Talk content modules into our resources
Joint Module
A Vital Talk x Understanding Dying Conversation Practice
Install on Their App
Provide API endpoints for Vital Talk App to Consume
We Point upward
Send clinicians wanting live depth to Train-the_Trainer & Launch
Vital Talk Points down
We’re the AI practice layer between live sessions
WHY US: A nimble, adaptable startup with a modular architecture ( Scenario Cards + API Endpoints ) and a science-driven evaluation service - built to plug a proven curriculum in fast, and prove with evidence that it stayed true to pedagogy