beginning of a more clear understanding by the patient and family of the reality of the situation. I realise that this situation may be different in the Asian culture.
However, as I describe the practical aspects of imparting information to patients and/or their families, you will see that it is patients and families who guide the conversations to a large degree and determine how much "truth" they can cope with3.
Firstly, I will just briefly go over some basic communication skills which put the rest of these guidelines into context.
1. The setting is important: wherever possible privacy should be provided and if not possible at least an illusion of privacy, that is, curtains drawn around the bed, and quiet, soft tones in speech. It is also important that the patient knows who you are. Sometimes it is the most senior doctor who breaks bad news, but this doctor may not be well known to the patient. It is extremely important to sit at the same level of the patient, or lower than the patient, and that the distance between you and the patient is comfortable. Even if it is necessary to talk to the patient about bad news during a ward round with others present, the person who is talking with the patient should sit, and try to create the atmosphere of a personal discussion. Touching the patient on the arm or hand may or may not be appropriate even in Western culture, so the health professional should be sensitively guided by the patient's reaction.
Presentation for the Life Planning Centre in Tokyo, Japan, 23 February 1997,
