[Communication of bad information: general indications and guidelines]

Breaking bad news to a patient requires from the physician specific communication skills and interpersonal abilities which, in the past, traditional medical curricula have tended to neglect. The authors present in this paper general guidelines for breaking bad news, illustrating how to structure the interview and how to evaluate patients' need for information before the communication of the diagnosis. A first step comprised the evaluation of how the patient perceives and interprets his illness and what type of information he wants to receive. The physician should establish the patient's actual knowledge of his illness which must be the starting point for the successive communication of the diagnosis. To facilitate patient's understanding of the news, the physician has to consider his perception of the illness, and to taylor the information he wants to convey accordingly. Patients' knowledge will be integrated gradually until the desired level of completeness is reached. It has to be considered that patients' need for information may change during the course of illness. Information giving is therefore part of a process. Physicians should be alert to possible changes and adjust the quantity and quality of information they give according to the changing needs of their patients.