[Communication of bad facts. To inform or not to inform the patient: a choice between 2 alternatives?].

In the last thirty years physicians changed their attitudes regarding the communication of the diagnosis to their patients. The prevailing tendency in the past to protect patients against emotional distress thought to be caused by the breaking of bad news has been replaced by the acknowledgment of the patient's right to be informed about their condition. This acknowledgement has not been accompanied by a different cognitive approach to patients: the decision to inform or not inform the patient about his/her diagnosis still depends more on doctor than on patient characteristics. It has been demonstrated that patients are usually not well informed and known less about their illness than doctors suppose they do. Technical jargon and unclear communication contribute to the patients' difficulty in understanding correctly the information provided by their doctors. If patients perceive genuine interest and feel supported by their doctors, only very few prefer not "to know". To be informed about the illness does not seem to be associated with increased emotional distress on the long term but, on the contrary, facilitates patients' adjustment to illness.