ABSTRACT
Breaking bad news should not be seen as a single event but a series of interactions over time. Sheldon (1993) noted that whether people express their needs depends on factors such as their expectations of treatment and their confidence in the ability of staff to help them. In my experience, the assessment of patients' and relatives' needs for information requires great sensitivity and skill from nurses, not only at the time of diag nosis, but in the following weeks or months of the terminal illness. As indicated in Chapter 3, awareness of a terminal illness does not always mean acceptance of its implications. Many people fear dying rather than death, imagining that they will have pain or other distressing symptoms and fearing that the doctors and nurses will be able to do little to help them. Relatives feel some degree of responsibility if a dying person is obviously suffering, and especially if they are caring for them at home. As nurses, we should help people to explore and express their anxieties so that we can give appro priate explanations and support. Nurses can usually give
genuine reassurance that dying will not be as distressing as they may imagine. In my research, patients with breast cancer indicated that their coping ability increased with the avail ability of support from their health visitors (Lugton 1994). Health visitors' availability reduced patients' uncertainty. Patients looked to them for information and advice and health visitors enabled patients to cope better with psycho logical problems. Health visitors' support appeared to follow a counselling model and often incorporated the three aspects of Egan's (1990) helping model (this model is explored more fully in Chapter 9):
• Level 1 - The present scenario • Level 2 - The preferred scenario • Level 3 - Strategy: getting there.
