Reinforce what you are saying, the patient needs to hear the information more than once. You may ask the patient to repeat back to you what you have been saying, or you may repeat some important points yourself or you may add to what you are saying with hand drawn diagrams or key points. What we say can so easily be misunderstood, for example
Doctor : "All the nodes I removed, everyone of them was infected with Cancer."
The patient heard: "He got all the Cancer."
Try to blend what you are saying with what is important to the patient. For example, increased drowsiness may prompt you do discuss some aspects of disease progression with the patient, so that they can participate in making a decision about what to do next, but the immediate problem of drowsiness is still there and also needs to be addressed. Sometimes the patient may bring up seemingly unrelated issues to what you are talking about. This may be a message that the conversation should be adjourned, or it may lead to a concern which does relate back to the conversation, for example, you may be saying that the disease has recurred, and the patient tells you that their daughter started school yesterday.
5. Responding to the patient's feelings is part of breaking bad news. The way that we react to the patient's reactions determines our future relationship with them, from the perspective that the patient might find our support helpful. Central to our reaction should be an empathic response and an assessment of the patient's response, which may be incorporated into making a plan.
Presentation for the Life Planning Centre in Tokyo, Japan, 23 February 1997,
