There is increasing awareness of the need for effective communication in health care, particularly with people who face a frightening diagnosis and an uncertain future for themselves or someone close to them.

Recent research suggests that most patients wish to know their diagnosis and the progress of treatment and disease. This may conflict with health professionals' need to protect their patients and retain an optimistic message even when the outlook is very poor.

Effective communication depends not only on the professionals but also on patients and carers. Language may be ambivalent, leading to genuine misunderstandings, and the needs of patients and carers do not always match. This may lead to health professionals feeling as though they are “pig in the middle” as they try to meet the needs of their patient and those of relatives.

When communicating with patients and relatives about incurable and life threatening disease, health professionals should remember to give attention to the environment and the physical comfort of all concerned. Standing in a corridor or a waiting room is unsatisfactory for everyone. Taking a patient or relative to a “quiet room” to discuss painful and difficult issues has the advantage of signalling the importance of the meeting and the fact that the news may be bad. Many patients, however, prefer to be in their own bed space, with the illusion of privacy given by drawn curtains. This is because the bed and surrounding space is the patient's territory, where he or she feels most in control.

Bad news cannot be broken gently, but it can be given in a sensitive manner and at the individual's pace. Many patients are well aware of the seriousness of their situation, and this may be …