Managing emotions at decision points in care is a challenge in the time-limited environment of providing patient care. This is exacerbated for patients who navigate a system that has perpetuated socioeconomic and economic disparities in care. Shared decision-making (SDM) provides a paradigm for responding to the emotional and informational needs of patients with chronic kidney disease and diabetes. However effective SDM implementation requires flexible interviewing and dialogic skills. While practiced and rehearsed scripts of care can be efficient and delivered in a caring manner, they are not responsive to the unique needs of patients from marginalized communities. This presentation presents the results from two studies. The first explored patient and physician experience in delivering bad news. The second describes delivering bad news with the use of an on-line, values based decision aid. The results of these studies are supported with recommendations of provider strategies to maintain patient and family engagement in SDM and a review of on-line patient resources.