[Truth at the bedside--also with cancer patients?].

The emotional discussion on a frank information strategy towards cancer patients 10 to 15 years ago has fortunately become more objective today, not the 'if', but the 'how' is now important; however, psychologic problems in the confrontation with the terminally ill are still recognized, mainly in groups of physicians lacking personal contact with dying and death during postgraduate training and later practise. Improvement of primary information and of further adapted communication with cancer patients cannot be solved alone by a larger number of experienced oncologists, since these represent in most instances only the second or third medical authority approaching the patient with neoplastic disease. Therefore, more supporting and less prejudiced patient contacts should be provided by first-line medical care, i.e. the family physician or surgeon. However, a truthful information strategy is a personal challenge for the physician. It demands an individual preoccupation of the therapist with the basic questions regarding his own life and its impermanence. Critical peer-reviewed training (i.e. in discussion and Balint groups) can teach a balanced dimension for a difficult patient interview (information, emotional involvement, patient-oriented behaviour). Deviations from adapted behaviour such as over-identification can thus be recognized and prevented. Since coping with disease does not develop in a linear fashion from initial resistance and negation of disease to mature acceptance in many patients, experienced therapists may always encounter sudden new problems regarding communication and information; therefore, the requirements for a therapist regarding tact, sensitivity and readiness to learn are high. This overview is written in this intent from an oncologists point of view in order to provide practical hints for daily encounters with cancer patients.