Breaking bad news: realistic versus unrealistic hopes

Hope is an essential aspect of the therapeutic relationship between cancer patients and their carers. Realistic hopes provide considerable support, whereas unrealistic hopes can be destructive by impairing the ability to make appropriate decisions about future plans, treatment, and issues of personal importance. Realistic hopes exist for cancer patients at all stages of their illness. Provision of realistic hope facilitates the process of breaking bad news. In this article, the role of hope is explored. Appropriate hopes are identified from the time of pre-diagnostic work-up throughout the phase of definitive treatment and into the transition to palliative and supportive care. A practical approach is developed, which emphasises communication and listening skills, the importance of providing time and the benefits of intermediate goals that facilitate a gradual adjustment in hopes as the disease progresses.