PBS Frontline brought frank discussion about death and dying to American homes Tuesday night with “Being Mortal,” a passionate documentary based on Dr. Atul Gawande’s bestselling book of the same name.

Americans face many challenges in initiating end of life care conversations, said Gawande, a general surgeon at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute. Seriously ill patients often focus on “how to beat the steep odds against them” without hearing from doctors and caregivers about how certain aggressive treatments may worsen their final days and hours.

Instead of dying at home with supportive comfort care, as the vast majority of Americans wish, many end up in hospitals surrounded by emotional family members who disagree about their final wishes.

“All of the stuff you learned about in medical school is just a tiny little bit of what it means to be good at our jobs,” Gawande offered. “So many people have their death come as a total surprise.”

Most of the documentary centered on the reluctance of many surgeons and oncologists to engage dying patients in meaningful discussion about prognosis and care options.

“It’s always a challenge how to say it, that this is not working and I have nothing more,” said Dr. Lakshmi Nayak, a neuro-oncologist at Dana-Farber. “I have tried to deliver the information in pieces over a period of time.”

In one emotional scene, Nayak has difficulty explaining to a patient and his wife why she has no further curative therapy to offer for his aggressive brain tumor.

It may be up to the patient to ensure that his or her end of life wishes are honored, because physicians often will not, Gawande cautions.

Dr. Monica Williams-Murphy, an award-winning writer and emergency physician at Huntsville Hospital in Alabama, called the documentary a “great introduction to how Americans may face death.” However, she would have liked it to explore diseases beyond cancer.

“As an emergency physician, I see death that is both expected and unexpected. We have all got to manage the many forms of being mortal better,” she told Life Matters Media. “Additionally, there was no mention of advanced directives, something that everyone over 50 absolutely should have. Conversations upstream in health care may ease the medical moments portrayed in the film.”

An advance directive may take the form of a living will, power of attorney for health care or do-not-resuscitate order. The purpose of such forms is to help ensure one’s end of life wishes are honored in case of illness or incapacity. Nationally, only 30 percent of adults die with advance directives.

Dr. Karen Wyatt, a family practice physician and end of life care advocate, said she would have liked the documentary to have explored benefits of earlier hospice enrollment. Hospice care is designed to help comfort terminally ill patients in their last months of life. The goal is not cure, but symptom management.

“The film barely touched the surface of what we need to talk about, but it was a great introduction to end of life issues. An appetizer,” she told LMM. “If a hospice physician would have created the film, it would have been entirely different. Those of us who care for dying patients in their home see an entirely different end of life experience.”

Wyatt said she believes some physicians will be inspired to start talking about death and dying with their terminally ill patients earlier.

“Gawande comes from within the hallowed halls of Western medicine and speaks directly to his colleagues,” she added. “He has credibility.”

Viewers were encouraged to tweet their reactions and share what matters most to them during the hour-long program (#WhatMattersMost and #BeingMortal quickly became trending topics, after thousands of messages were sent).

For me, #WhatMattersMost: not my body but a mind that still works well enuf to connect with the people that matter to me. #BeingMortal — Atul Gawande (@Atul_Gawande) February 11, 2015

Grateful my husband's Drs started hospice when it was time, giving quality time over quantity #beingmortal #whatmattersmost @Atul_Gawande — Angela Schlaack (@angelaschlaack) February 11, 2015

#WhatMattersMost Remembering, as my dear Mother taught me, you begin dying the day you are born. .@frontlinepbs .@Atul_Gawande #BeHereNow — Elin Silveous (@ElinSilveous) February 11, 2015