HomeGuidelinesPlanning and follow up     When you are sure that the bad news has been absorbed and first reactions have been addressed, it is important to discuss the future in terms of further investigations, treatment options and support. Honesty is an important element of these discussions rather than being over optimistic. The patient will need realistic reassurance about the future. Even when it is not possible to offer a cure, plans can be made for symptom control and support. A follow-up appointment should be made and a contact number given so that the patient may access a member of the team. If the bad news has been broken in an outpatients department, it is important to check that the patient is not in shock when they leave, perhaps to drive home alone. If the patient appears very distressed, it could help to offer to contact a friend or relative to come and be with them and take them home. Remember that, later, the patient may ask questions about treatment, prognosis and other aspects of their future. This could mean more bad news and the need for you to check understanding and, perhaps, to reiterate information to reinforce the message. Hope is an important concept in the bad news situation. Often the patient is given inappropriate reassurance in order to maintain hope. For someone facing a life-threatening diagnosis or a terminal illness, the doctor's hope, that a cure can be offered, is unrealistic. In such a situation, when the patient has accepted the reality of their situation, they should be encouraged to set realistic goals for the future. Avoid expressions such as "What you need to do is.." since only the patient knows what is most important to them. Mr Andrews has been diagnosed with advanced Prostate cancer, and is having difficulty accepting the news. His wife is with him to drive him home and seems less anxious than her husband. •  What issues would you wish to address with this couple before they leave the out patients department.        Printer friendly version  Click here	A time to share Getting started What does the patient know or suspect? Give information at patient's pace Sharing the information Giving space Handling reactions Planning and follow up Do's and don'ts