Patients receiving palliative radiotherapy (PRT) are more likely to receive other active treatments at the end of life, including mechanical ventilation and resuscitation. Delayed or inadequate communication between patients and clinicians can further contribute to treatment that is inconsistent with patient goals and priorities. Prior randomized data has demonstrated that use of a serious illness conversation (SIC) guide by providers yields more frequent, earlier, and higher quality patient-centered discussions at the end of life. The use of this guide was implemented broadly by our cancer center in 2017 and 2018. Given the comparable outcomes of various fractionation schemes for bone metastases (BM), we hypothesized the presence of a documented SIC would be associated with a reduced number of prescribed fractions for patients receiving PRT for BM. We performed a retrospective analysis of patients receiving PRT for BM with or without a documented SIC within 90 days of PRT. We compared patient-specific factors and outcomes (demographic variables, radiation treatment parameters, SIC factors, and median survival) between the two groups. Fisher’s exact and Wilcoxon Rank Sum tests were performed to examine differences between categorical and continuous variables, respectively. We used Kaplan-Meier analysis to analyze survival. A total of 378 courses of PRT were delivered to 300 patients with BM from 9/2017 to 2/2020. SICs were documented for 140 (37.0%) PRT courses delivered to 110 (36.7%) patients (SIC+). No SICs were documented for 238 (63.0%) PRT courses delivered to 190 (63.3%) patients (SIC-). Median age was 62 in the SIC+ cohort and 65 in the SIC- cohort. Patients receiving SICs were significantly more likely to be <70 years old, (76% vs. 63%, p = .012), receive total dose ≤20 Gy (74% vs. 55%, p<.001), receive course 3 or higher of RT (56% vs. 37%, p<.001), and be prescribed 2 or fewer fractions per course (29% vs. 19%, p = .043). Median survival did not significantly differ between the two groups (2.8 versus 2.4 months, p = 0.26). Of the SIC+, 62.1% were documented by Medical Oncologists versus 13.6% by Radiation Oncologists (ROs). Documented SIC was associated with shorter length of prescribed PRT for BM in a population whose median survival was <3 months. Incorporating SICs into PRT workflows may thus help align treatment decisions with patient priorities, minimize travel burden, and reduce cost of care. Importantly, as a majority (>60%) of patients did not have documented SICs and <15% of conversations were documented by ROs, there are clear opportunities to improve the rate of provider (especially RO) participation in SICs. Our study also demonstrates that patients receiving SICs were more likely to be younger, highlighting an opportunity to improve patient-clinician communication in older patients with advanced cancer.