He had been in treatment for bone cancer and though his condition had not significantly improved, he expected it would soon turn around with immunotherapy.

Nobody told him how close he stood to the void.

By the time palliative care director Maria Cigolini met him in emergency, he was gasping for life.

It was up to her to tell him he was dying and prepare him for the event three weeks later.

"He was not expecting that he was actually dying because it was never discussed with him," Dr Cigolini said.

"Most specialists in other disciplines, their role is to keep people alive and try to cure them as much as possible and that creates a different type of conversation with patients.

"Especially with young people, it's a highly charged area. They don't have a structure to offer other things to that patient and they feel like they're giving up if they don't offer treatment."

Research shows palliative care not only makes the last months of life more comfortable, it can also prolong life by reducing depression and anxiety and reduce costs by keeping patients out of hospital longer.

Palliative care improves the quality of life for patients with life-threatening illness by providing relief from pain and other symptoms, and intends neither to hasten nor postpone death.

But palliative care doctors say they are often not involved in the care of patients until their final days or hours, by which time many have pursued costly treatments with wretched side effects.

NSW Health Minister Brad Hazzard is seeking advice from the industry through a series of community forums to improve access to palliative care.

More than half of all deaths in Australia occur in hospitals, though more than 70 per cent of people say they would prefer to die at home.

"Some of the issues are blindingly obvious but extremely challenging," Mr Hazzard said.

"We have a whole range of specialists who are trying to keep people alive - and trying to give them a good death comes perhaps as an afterthought."

Dr Cigolini said specialties such as intensive care specialists, cardiologists and respiratory physicians should receive training in palliative and best supportive care in medical school and through their professional colleges.

It was common for patients with no chance of a cure to be receiving active treatment up until the day they died, she said.

"Sometimes, doctors don't have the language to get patients ready for dying. It's not because the doctor can't be bothered or because the doctor doesn't care."

St Vincents Hospital palliative care director Richard Chye said a large portion of the work done in public hospitals was futile.

"There are surgeons who do operations that all of us in palliative care know is a waste of time, and the reason for that is doctors don't know how to say no," Dr Chye said. "They're scared to say no.

"We're a very death-denying society. We're a very death-denying health system."

Palliative care nurse Linda Ora said that when she visited aged care centres the residents and families had often not discussed end-of-life decisions with staff.

"I feel that palliative care should be considered core business for aged care facilities and I don't get the feeling that it is," Ms Ora said.

Although most families wanted medical staff to do all they could to treat infections and symptoms when they arose, most preferred for the patient to die comfortably than undergoing active treatment when they were given the choice, she said.