Background: Palliative care can help enhancing the quality of life of the terminally ill geriatric patients. Supporting the family in caring for elderly patients with end stage renal diseases (ESRD) and are on hemodialysis is the key part of palliative care. Aim of the study: was to evaluate the effect of a palliative care support program for family caregivers of end stage renal disease terminally ill geriatric patients. Subjects & methods: Research design: Quasi experimental research design was used (One group pretest-posttes). Setting: Dialysis unit in Al Moassat Alexandria University Hospital and family caregivers/ geriatric patients own homes. Subjects: Convenience sample of 45 family caregivers of geriatric patients with ESRD. Tools of data collection: 1) Family caregivers' socio demographic and clinical data structured interview schedule 2) Health profile of geriatric patients with ESRD structured interview schedule. 3) Palliative Care Knowledge Scale (PaCKS). 4) Family caregivers' practices of palliative care structured interview schedule. Results: knowledge and practices of the majority of the family caregivers have improved after the implementation of the study intervention than before the intervention, and the difference is a statistically significant (p<.001). Conclusion: The palliative care support program proved to be effective in improving knowledge and practices of the family caregiver of terminally ill geriatric patients with ESRD. The study hypothesis was supported by the study data. Recommendations: Inclusion of the study developed a palliative care support program in the plan of care for terminally ill geriatric patients with ESRD in all relevant health care settings.