Background

Advances in cancer treatment have resulted in decreases in the incidence of most cancers and also increased patient survival. However, physicians treating cancer patients can expect that, for many patients, the hope of cure, treatment benefit, or sustained remission will not be met. Even for patients who have satisfactory outcomes there are many times during the course of the illness where the physician must undertake the difficult and unavoidable task of conveying unfavorable information about the illness or discussing emotionally charged issues such as

• the diagnosis of cancer (especially when metastatic disease has been found)

• cancer recurrence, spread of disease or failure of treatment to affect disease progression

• the presence of irreversible disease or of serious treatment toxicity

• hospice care and cardiopulmonary resuscitation when no further treatment options exist

• positive results of genetic tests.

Goals of giving bad news

Studies have shown that in Western societies most patients desire to have complete information about their illness, its prognosis, and treatment possibilities.– Many also wish to participate in the important decisions about cancer treatment. Although bad news often upsets the patient, the physician can move from being the messenger of bad news to actually promoting coping by providing empathic understanding and concern. Employing communication skills in addressing patient's emotional needs are an expression of solidarity and can enhance the patient's trust and confidence in the physician.

What is bad news?

Bad news may be defined as “any information that seriously and adversely affects one's view of the future.